Chronic obstructive pulmonary disease as a systemic disease: an epidemiological perspective: Fig. 1.—

Abstract

Chronic obstructive pulmonary disease (COPD) has been increasingly recognised as a systemic disease. The hormonal, metabolic and musculoskeletal implications of the generalised processes involving oxidative stress, inflammatory mediators, cytokines, and endocrine hormones have only begun to be understood.Only a few studies have looked into the epidemiology of inflammatory markers in patients with chronic obstructive pulmonary disease. Common extrapulmonary effects of chronic obstructive pulmonary disease include skeletal muscle dysfunction, wasting and osteoporosis. The resulting effects of a systemic inflammation can be measured at specific extrapulmonary organs such as skeletal muscle or in more general terms using body composition, body weight or derived measures, and only a few studies have set the parameters in an epidemiological context. Nevertheless, these studies indicate an association between inflammatory markers and forced expiratory volume in one second not only in subjects with severe chronic obstructive pulmonary disease. Also, it is increasingly clear that systemic markers in chronic obstructive pulmonary disease have important effects on prognosis. Eur Respir J 2003; 22: Suppl. 46, 2s-4s.

Antioxidants, oxidative stress, and pulmonary function in individuals diagnosed with asthma or COPD

“…We did, however, find lower serum concentrations of lutein/zeaxanthin, lycopene, b-cryptoxanthin, retinol, and b-carotene in men and women in the CAL group as compared to those without (Po0.05) (Schünemann et al, 2001b). So, similar intakes and lower concentrations in peripheral blood suggest that the disease process may deplete antioxidant capacity, perhaps via oxidative stress (Taylor et al, 1986), or via other related metabolic processes that are associated with systemic inflammation (Andreassen and Vestbo, 2003). Further evidence supporting antioxidant depletion comes from the low correlations between serum and dietary antioxidant measurements in this study; coefficients ranged from 0.12 to 0.22 for the carotenoids.…”

Outcomes for COPD pharmacological trials: from lung function to biomarkers

“…However, their level of involvement has since been questioned due to the crosssectional methodology used and the lack of information regarding the temporal aspects and biological plausibility of this observed association [569]. Previous studies [566,568,[570][571][572][573][574][575][576][577][578][579][580][581][582][583][584] have suggested roles for systemic CRP, fibrinogen, leukocytes, TNF-a, IL-6 and IL-8 in COPD and its exacerbations, but more longitudinal randomised controlled studies with larger sample sizes are needed to confirm their specificity and sensitivity as biomarkers in patients with reduced lung function [441].…”

Systemic Inflammation in COPD

“…As previously mentioned, low-grade systemic inflammation is present even in patients with stable COPD, 5,79 where changes in peripheral blood cells and increased plasma levels of C-reactive protein (CRP), fibrinogen and proinflammatory cytokines have been consistently demonstrated 5,8,[43][44][45]84,85 (Table 2). Some of these changes appear to be related to the severity of the disease.…”

“…Markers of inflammation and/or oxidative stress in active smokers include TNF-␣, different interleukins, isoprostanes, nitric oxide, and hydrogen peroxide. 79 When COPD is established, a wide number of inflammatory markers can also be detected. Other factors that may also be involved in the development of systemic inflammation are the inhalation of other substances, such as those contained in wood smoke or in urban pollution, shear stress and hypoxia.…”