**7.2 Anti-inflammatory strategies**

Strategies to reduce the burden of lung inflammatory cells in COPD would thereby reduce the amount of proteinase that they are responsible for releasing. Inhibitors of phosphodiesterase E4, the major isoenzyme in inflammatory cells, decrease inflammatory cell migration, activation, and release of proteinases. Clinical trials of phosphodiesterase E4 inhibitors in COPD have resulted in one selective PDE4 inhibitor, roflumilast (Daxas ®), being approved for use in humans and available in Canada and the European Union in 2011 for the treatment of a specific population of patients with severe COPD (147). Other antiinflammatory approaches, such as inhibiting NF-B activation to reduce pro-inflammatory gene expression, could also potentially inhibit proteinase- and oxidant-mediated lung injury in COPD patients.
