Pulmonary Interstitial Emphysema Medication

Updated: Jun 25, 2019
  • Author: Abhay J Bhatt, MD, MBBS; Chief Editor: Muhammad Aslam, MD  more...
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Medication Summary

The principal therapies for pulmonary interstitial emphysema (PIE) are lateral decubitus positioning, selective intubation, occlusion of the contralateral bronchus, and high-frequency ventilation. However, administration of surfactant to premature infants (< 30-32 weeks' gestation) judged to be at risk of developing respiratory distress syndrome may reduce the risk of PIE development.


Lung Surfactants

Class Summary

These agents prevent the alveoli from collapsing during expiration that results from deficient or ineffective endogenous lung surfactant in neonates. There are two different kinds: Natural and Synthetic.  It is for intratracheal administration only. Surfactant prevents alveoli from collapsing during expiration by lowering the surface tension between air and alveolar surfaces. Surfactant  is used for prophylaxis and treatment of respiratory distress syndrome (RDS) in premature infants.


Natural Sufactant

Beractant (Survanta®), Poractant (Curosurf®), Calfactant (Infasurf®)

It is derived from animals. It has been considered the superior subtype, due to its greater efficacy in mimicking the action of human surfactant. The value between the two subtypes has yet to be fully elucidated. Bovine samples are most commonly used followed by porcine extracts. Despite the positive findings when natural surfactant is administered, there are a number of drawbacks, including the lack of cost-effectiveness, inconsistent efficacy, possible anaphylactic shock reaction, and risk of pathogen contamination. It is important to note that the pathogenic risks have not been identified on a clinical level.

Beractant (Survanta®) is animal surfactant derived from minced bovine lung extract, with the added products of DPPC, palmitic acid and tripalmitin.

Poractant (Curosurf®) is derived from minced porcine lungs.

Calfactant (Infasurf®) is another bovine surfactant extracted by broncho-alveolar lavage


Synthetic surfactants

Exosurf®, Lucinactant (Surfaxin®)

It is produced synthetically in laboratory.  Previous synthetic surfactant only contained phospholipids, with colfosceril palmitate (Exosurf®) the most commonly trialled protein-free synthetic surfactant The prime factor has been the development of protein-containing synthetic surfactant. It had been shown that its therapeutic effect was inferior to that of natural surfactant. The rise of protein-containing synthetic surfactant, such as lucinactant (Surfaxin®), has offered scientists a new avenue to further expand upon our advancement in surfactant as its action has been hypothesised to be as effective as, or even better than, natural surfactant.