Alpha-1-antitrypsin and other proteinase inhibitors

► Protease/antiprotease imbalance is one of the recognized causes of pulmonary emphysema in smokers and patients with AAT deficiency. ► Augmentation therapy with intravenous AAT reduces the progression of loss of lung density in patients with congenital emphysema. ► Optimization of intravenous regimen must be made on an individual basis based on the pharmacokinetics of infused AAT. ► The search for novel antiproteases that could potentially be used in smokers COPD is an ongoing field of intense research.