**5. Summary**

Emphysema can be a preventable and equally treatable pulmonary disease. With the advent of new diagnostic criteria such as the emergence of a key biomarker, circulating levels of EMP may lead to efficient diagnosis and preventative care. Patients with emphysema can present a varying array of symptoms and physical examination findings. While the majority of patients can be managed with medical therapy, those who continue to progress may require surgical intervention based on their diagnostic studies. The ideal surgical treatment of emphysema is dictated by a rigorous selection criteria for each of the possible interventions described and can dramatically improve the quality of life of individuals inflicted with this disease. New and innovative methods for treating crippling emphysemic patients who are not candidates for surgical treatments include bronchoscopic placement of one-way valves into diseased segments of lung tissue or airway bypass by means of inserting stents between bronchi and adjacent lung tissue [75-78], however, these emergent techniques necessitate further exploratory and long term studies.

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**Diverse Activities for Proteinases** 

**in the Pathogenesis of Chronic** 

**Obstructive Pulmonary Disease** 

COPD remains a major public health problem. It is the fourth leading cause of chronic morbidity and mortality in the United States, and is projected to rank fifth in 2020 in burden of disease caused worldwide, according to a study published by the World Bank/World Health Organization. COPD is a preventable and treatable disease, with some significant extra-pulmonary effects that may contribute to the severity in individual patients. Its pulmonary component is characterized by airflow limitation that is not fully reversible. The airflow limitation is usually progressive and associated with an abnormal inflammatory response of the lung to noxious particles or gases. Smoking remains the major risk factor for

Inhalation of cigarette smoke and other pollutants leads to a chronic inflammatory process in the small airways and the lung parenchyma, which includes an influx of macrophages, polymorphonuclear neutrophils (PMN), T lymphocytes (with CD8+ T cells exceeding the numbers of CD4+ T cells), and B lymphocytes (1-4). This inflammatory process over a prolonged period, leads to destruction of the alveolar walls leading to airspace enlargement, loss of lung elasticity, closure of small airways, and irreversible airflow obstruction. Pathological changes also include mucous metaplasia and mucus hyper-secretion. The small airways narrow due to the combined effect of mucus plugging, inflammation in the airways walls and lumen, and subepithelial fibrosis and can become obstructed (1). COPD is a complex disorder with many processes at play but there is strong evidence that proteinases make critical contributions to all the pathologic processes detected in the lungs of COPD

Proteinases are named for their action, i.e. to cleave the internal peptide bonds of polypeptides. In human biology they are classified into 4 groups based on the chemical

this disease, but inhalation of other pollutants and genetic factors also play a role.

**1. Introduction** 

patients.

 

**2. Classification of proteinases** 

Corresponding Author

Emer Kelly and Caroline A. Owen

*Medical School, Boston, MA* 

*USA* 

*Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital and Harvard* 

[78] Reilly J, Washko G, Pinto-Plata V, et al. Biological lung volume reduction: a new bronchoscopic therapy for advanced emphysema. Chest. 2007, 131(4):1108-1113. **4** 
