Chronic obstructive pulmonary disease (COPD) is a major focus of both scientific and clinical interest in the Section of Pulmonary, Critical Care and Sleep Medicine. Drs. Jack Elias, Charles Dela Cruz, Min Jong Kang, and Chun Geun Lee have recently identified novel mechanisms that likely contribute to the pathogenesis of pulmonary emphysema using transgenic and other mouse models of emphysema and airways inflammation. Numerous members of PCCSM are currently collaborating in translational studies that are testing the applicability of these findings to human disease, investigating the molecular mechanisms underlying clinical heterogeneity in this disorder and the factors that affect the rate of decline in lung function among COPD patients. Clinical faculty members with particular expertise and interest in COPD include Dr. Carolyn Rochester (Winchester Clinic and VA) and Dr. Hilary Cain (VA). A broad base of patients with COPD, ranging from those with mild disease to those in need of rehabilitation, assisted ventilation or under consideration for Lung Volume Reduction Surgery or Lung Transplantation are seen at the Winchester Chest Clinic COPD Center and the two campuses (West Haven and Newington) of the VA-CT Medical Center. An outpatient Pulmonary Rehabilitation Program was developed at the West Haven VA to improve the functional capacity, exercise tolerance and symptoms of patients with COPD and other forms of chronic respiratory disease. Drs. Rochester and Cain are also participating in a multi-center, randomized, placebo-controlled trial investigating the effects of the long acting anticholinergic, Tiotropium, on lung function in COPD (based at the West Haven VAMC).