Preventive Therapy for Chronic Lung Disease

Abstract

To the Editor. We read with great interest the article by Stiskal and colleagues titled “α1-Proteinase Inhibitor Therapy for the Prevention of Chronic Lung Disease of Prematurity: A Randomized, Controlled Trial.”1 As pointed out in the article, chronic lung disease of prematurity (CLD) or unresolved neonatal acute lung injury is a multifactorial disease, with lung immaturity, barovolutrauma, and oxygen toxicity being the most widely recognized and studied precedent factors. CLD continues to be one of the most commonly encountered complications of prematurity despite surfactant displacement and improved ventilatory management strategies aimed at minimizing injury to the immature lung. Even though evidence from numerous descriptive studies over the past 2 decades, using tracheal aspirate samples as the representative milieu of the airways, has suggested a role for inflammation and unfavorable proteinase/antiproteinase balance in the development of CLD, there has been considerable lag time in hypothesis testing in both the laboratory and clinical settings. We, therefore, congratulate Stiskal and his colleagues on their effort to taking the proteinase/antiproteinase imbalance theory a step forward, to be …