At the age of 47 the patient was found to have alpha-1-anti-trypsin deficiency. She had progressive shortness of breath until full disability at the age of 57. She also developed diabetes with chronic renal insufficiency and hypertension.

Cxr at 55 years of age

1. What is the cause of alpha-1-antitrypsin deficiency?

2. What is the prognosis for this patient?

3. What treatment can be offered her?