TY - JOUR T1 - Undiagnosed coeliac disease in patients with emphysema: a fortuitous association? JF - European Respiratory Journal JO - Eur Respir J SP - 453 LP - 456 DO - 10.1183/09031936.00020210 VL - 36 IS - 2 AU - M. De Menthon AU - D.J. Dusser AU - L. Guillevin AU - P.R. Burgel Y1 - 2010/08/01 UR - http://erj.ersjournals.com/content/36/2/453.abstract N2 - To the Editors:Chronic obstructive pulmonary disease (COPD) is characterised by progressive and poorly reversible airflow obstruction due to small airway disease and emphysema. Cigarette smoking is the major cause of COPD, but the disease also occurs in nonsmokers. In nonsmokers, environmental factors (e.g. second-hand smoking and inhalation of toxic gas), genetic factors (e.g. the rare α1-antitrypsin deficiency) and infectious factors (e.g. HIV infection) have been implicated in the pathogenesis of the disease. We report on two cases of COPD with emphysema in nonsmokers with long-standing undiagnosed coeliac disease.A 71-yr-old female was referred to our hospital (Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France) for dyspnoea and cough, which had evolved over 5 yrs. She had suffered from alternating diarrhoea and constipation for many years, ascribed to functional bowel disease. She had never been exposed to inhaled toxics and had never smoked. Examination revealed a body mass index (BMI) of 18 kg·m−2 and a chest computed tomography (CT) image revealed pulmonary distension and emphysema (fig. 1). Spirometry revealed severe airflow limitation (table 1). Serum α1-antitrypsin was normal. Treatment with long-acting bronchodilators was initiated. After 7 yrs of follow-up, the patient complained of progressive weight loss (BMI 15 kg·m−2 … ER -