Pulmonary emphysema: Etiological mechanisms and therapeutic approaches

In the past three decades, significant progress has been made in the understanding of chronic obstructive lung disease from the standpoint of its clinical course, the etiological mechanisms of alveolar and bronchial injury, potential biochemical mechanisms of early detection of the disease and, most recently, therapies in the form of natural and synthetic inhibitors of neutrophil elastase which are approaching evaluation for clinical efficacy. In spite of this progress, chronic obstructive lung disease and its constituents of chronic bronchitis and emphysema remains a complex clinical entity of worldwide significance. There still remain crucial questions in our understanding of this disease, some of which have been listed in Table I. Hopefully, these are questions which will occupy the efforts of clinicians and investigators in the coming years, while we apply therapies from the knowledge already gained.