COPD Pathogenesis: Finding the Common in the Complex.

Developing an effective treatment for chronic obstructive pulmonary disease (COPD), and especially pulmonary emphysema, will require an understanding of how fundamental changes at the molecular level affect the macroscopic structure of the lung. Currently, there is no accepted model that encompasses the biochemical and mechanical processes responsible for pulmonary airspace enlargement. We propose that pulmonary emphysematous changes may be more accurately described as an emergent phenomenon, involving alterations at the molecular level that eventually reach a critical structural threshold where uneven mechanical forces produce alveolar wall rupture, accompanied by advanced clinical signs of COPD. The coupling of emergent morphological changes with biomarkers to detect the process, and counteract it therapeutically, represents a practical approach to the disease.