The two main factors causing imbalance between elastase and Alpha 1 Antitrypsin are :

  • Cigarette smoking (Smoker’s emphysema) : Toxic effect of cigarette smoke and other pollutants causes.
    • Increased release of elastase from cells normally found in the lungs.
    • It stimulate the elastase producing cells to migrate to the lungs which in turn causes an increased release of elastase.
    • Inactivity of enzymes that inhibit elastase activity.

This increased elastase causes destruction of the elastin present in the alveolar walls causing damage to the alveoli.

  • Hereditary deficiency of a blood component, Alpha 1 Protease inhibitor, also called as Alpha 1 Antitrypsin (AAT) (Familial emphysema) : Normally AAT helps in inhibiting the enzyme elastase, but in its absence the activity of elastase is not inhibited and there is breakdown of elastin causing damage to the alveolar wall.