ABSTRACT
The last 30 years has been a time of significant advances in lung biology and medicine as related to pulmonary surfactant: the material has been isolated and analyzed, the genes of the proteins cloned, some progress achieved in understanding the complicated hormonal events involved in lung maturation and parturition, and substantial improvement has evolved in diagnosing and managing patients with acute and chronic lung injury, especially neonates with hyaline membrane disease (HMD). The legacy of this progress in saving increasingly smaller and more immature babies has been the emergence of a larger number of premature neonates with chronic lung disease (bronchopulmonary dysplasia; BPD) whose prolonged management to a successful outcome is still problematic. Likewise, since the first report on adult patients with chronic lung disease sharing the commonality of noncardiogenic pulmonary edema (1; adult respiratory distress syndrome; ARDS), there is now a substantially greater appreciation of the cellular processes involved in the evolution of this condition, although unfortunately, it has not yet resulted in substantial progress in treating this syndrome. This chapter concentrates on one rather limited aspect of these chronic lung injuries in the newborn and the adult-the potential involvement of pulmonary surfactant. Al-
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though the importance of pulmonary surfactant is clear and favorably exploited in the treatment of HMD, its role in BPD is far less certain. Patients with ARDS sometimes manifest changes in the properties and composition of pulmonary surfactant that are evident and readily linked to the pathophysiology. In other patients, the correlations are less sure. This chapter will attempt to summarize current information on surfactant in chronic lung injury in both the adult and neonate, for there is increasing evidence that many of the cellular events in both age groups are similar, although they may occur with different time courses and severities (2). Similar to most disease processes, the pathophysiological outcome is a result of several intervening factors, of which surfactant is but one, and this is apparent by the many topics covered in this volume. We will not attempt to provide comprehensive coverage of all aspects of the injury processes. The experiments and clinical cases that are included herein were chosen because of their intended design or emphasis on questions of surfactant, possibly to the exclusion of other factors that also may be affecting etiology and outcome in patients or experimental animals.
