Cell Dysfunction as a Precursor of Pulmonary Disease

A pressing need in the field of chronic pulmonary disease is the development of methods to detect predisposition to pulmonary disease. During the 1950's, the epidemiologist identified the many etiologic factors in chronic pulmonary disease by utilizing a few simple clinical and physiologic tools. These tools, however, are good enough to detect only established disease. It is now apparent that current therapy is not terribly effective in altering the long term course of already established disease.1 Although progress has been made in reducing the morbidity and mortality of acute exacerbations, treatment does not seem to have significantly influenced the inexorable progression of such disease. The idea is being increasingly accepted that chronic pulmonary disease has its origin years before the development of symptoms or even detectable physiologic abnormalities. It is conceivable that "pre-disease" detection, or the detection of risk factors, could reduce the chances for the development of the cycle of tissue damage that characterizes already established disease.