Past, present and future of the therapy of emphysema

Senile atrophic emphysema was for a long time a term used to describe the pulmonary structure of elderly people. Since emphysema occurs mostly in elderly people, it was understood as the premature occurrence of a more or less normal ageing process. Therefore, almost no therapy seemed to be possible. Later emphysema was thought to be the consequence of airway obstruction, where the narrowed bronchi behave as check valves, so that the trapped air leads to overinflation and rupture of the alveoli. Thus bronchodilators were tried in the prevention of emphysema. This concept was partially successful, but also without bronchial obstruction emphysema can develop and progress. Experiments by Gross suggested that emphysema is a self-digesting process in the course of inflammatory defence of the body. Thus the inflammatory process itself became the target of the therapy. Additional therapy was tried by teaching special types of breathing and by breathing exercises, but had rather small success. Today our interest is focused on the imbalance of oxidants and antioxidants as the main reason for the self-digesting process. We hope to correct this imbalance, but we must be careful not to block a useful defence mechanism of the body.