Pathogenesis of COPD. Part II. Oxidative-antioxidative imbalance [State of the Art Series. Chronic obstructive pulmonary disease in high- and low-income countries. Edited by G. Marks and M. Chan-Yeung. Number 3 in the series]

Chronic obstructive pulmonary disease (COPD) represents a serious global health problem that affects the aged. This State of the Art article summarises previous studies on oxidative-antioxidative imbalance in patients with stable COPD or in acute exacerbations. Recent literature in this field reports conflicting findings. Several studies on markers of oxidative stress have demonstrated increased production of oxidants in exhaled air, breath condensates or induced sputum. The primary defence against oxidants is endogenous antioxidants, which are altered in COPD. Some studies have demonstrated a marked decrease in plasma antioxidant capacity, while other studies have shown opposite findings. A few studies have shown higher erythrocyte superoxide dismutase (SOD) activity in COPD patients and healthy smokers than those in healthy non-smokers. In contrast, we found no differences in erythrocyte SOD activity and elevated erythrocyte catalase activity in Chinese patients with COPD compared with healthy smokers matched for age and pack-years smoked. Possible reasons for such discrepancies could be related to differences in inter-individual variations in antioxidant capacity as a result of different populations and also differences in methodologies between studies.