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The specific treatment of emphysema
G L Snider1, P J Stone, E C Lucey
1Boston Veterans Administration Medical Center, MA 02130.
The European Respiratory Journal. Supplement
|March 1, 1990
Summary
Elastase inhibitors may prevent emphysema in susceptible smokers. Identifying these individuals via airflow obstruction is key, as large-scale treatment studies are costly. Further research into disease development is feasible.
Area of Science:
- Pulmonary Medicine
- Biochemistry
- Toxicology
Background:
- Cigarette smoking is a primary cause of emphysema.
- The elastase-antielastase imbalance hypothesis suggests elastase inhibitors could prevent emphysema.
- Many smokers cannot quit despite support.
Purpose of the Study:
- To explore the potential of elastase inhibitors in preventing emphysema.
- To identify methods for studying emphysema development in susceptible individuals.
- To assess the feasibility of studying emphysema pathogenesis.
Main Methods:
- Review of various elastase inhibitor properties (solubility, binding, molecular weight).
- Analysis of animal models and human studies regarding inhibitor efficacy.
- Discussion of identifying susceptible smokers through airflow obstruction.
- Proposal for process studies using biomarkers like lung elastase load and urinary desmosines.
Main Results:
- Inhibitor effectiveness varies: irreversible and slow-clearing reversible inhibitors show promise.
- Small, rapidly clearing reversible inhibitors may worsen emphysema.
- Only 15% of smokers are susceptible, identifiable by airflow obstruction.
- Outcome studies are expensive, but process studies are feasible.
Conclusions:
- Targeted elastase inhibitor therapy could prevent emphysema in susceptible individuals.
- Biomarker-based process studies are a feasible alternative to expensive outcome trials.
- Further research is needed to understand emphysema pathogenesis and develop effective treatments.