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Stockley RA et al. – Emphysema distribution has facilitated further understanding of physiologic impairment with particular reference to discordance between FEV1 and tests of gas transfer. The condition also emphasizes the role of the neutrophil in the inflammatory cascade in both deficiency and usual COPD. Deregulation and resistance of the inflammatory cytokine cascade appears to be a regular feature of usual COPD, and may represent a premature ageing phenotype. Molecular studies provide new insights that may lead to specific therapies to halt progression.

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