Indicators of oxidative stress and inflammation in chronic obstructive pulmonary disease patients with co-morbidity

Hronična opstruktivna bolest pluća (HOBP) je hronična inflamatorna bolest koja zahvata gornje i donje disajne puteve, parenhim pluća i plućnu vaskulaturu. Procenjuje se da u našoj zemlji od hronične opstruktivne bolesti boluje izmeĎu 400 000 i 600 000 ljudi. U svetu je više od 600 miliona obolelih od ove bolesti, sa blizu 3 miliona smrtnih slučajeva godišnje, čineći je petim uzročnikom smrtnosti u ljudskoj populaciji. Procenjuje se da će u budućnosti broj obolelih rasti i do 2020. godine biti treći uzročnik smrtnosti. Ranijih godina je definicaja hronične opstruktivne bolesti pluća bila bazirana na plućnoj patologiji, tj. na progresivnoj opstrukciji disajnih puteva. Smatralo se da je promenjeni inflamatorni odgovor pluća na inhalirane toksične partikule i gasove iz duvanskog dima, aerozagaĎenja i ostalih zagaĎivača glavni mehanizam u patogenezi ove bolesti. MeĎutim, poslednja istraživanja ukazuju na složen mehanizam nastanka i razvoja ove bolesti, koji pored pojačane inflamacije uključuje i izražen oksidativni stres i pojačanu proteolizu ekstracelularnog matriksa (ECM), a kao posledica disbalansa proteaza/antiproteaza sistema. Hroničnu opstruktivnu bolest pluća karakterišu i stanja egzacerbacije bolesti. Egzacerbacija HOBP definiše se pogoršanjem respiratornih simptoma u odnosu na predhodne dnevne varijacije, koje zahtevaju promenu u tretmanu lekovima. Učestalost ovog stanja odreĎuje težinu i ishod HOBP. Bitna karakteristika HOBP je i veliki broj komorbiteta, nastalih u najvećem broju slučajevima kao posledica delovanja upravo pojačane inflamacije, oksidativnog stresa i proteolize ECM. MeĎu ovim bolestima najzastupljenije su bolesti kardiovaskularnog sistema, osteoporoza, disfunkcija skeletnih mišića, depresija...Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory disease involving the upper and lower airways, lung parenchyma and lungs vasculature. It is estimated that in our country 400 000 to 600 000 people with chronic obstructive pulmonary disease. There are more than 600 million COPD patients worldwide, and with close to 3 million lethal cases per year, COPD is the fifth cause of mortality in human population. It is estimated that the number of these patients will rise in future, and by 2010 the disease will become the third cause of mortality. In previous years the definition of chronic obstructive pulmonary disease was based on pulmonary pathology, i.e. progressive obstruction of airways. It was considered that an altered inflammatory pulmonary response to the inhaled toxic particles and gases from tobacco smoke, air pollution and other pollutants was the main mechanism of the pathogenesis of this disease. However, the latest investigations have shown a complex mechanism of occurrence and development of this disease, which besides an increased inflammation also includes an increased oxidative stress and intensified proteolysis of the extracellular matrix (ECM), as a consequence of disbalance of the protease/antiprotease system. Chronic obstructive pulmonary disease is also characterized by the states of exacerbation of disease. Exacerbation of COPD is defined as deterioration of respiratory symptoms in relation to the previous daily variations, requiring a change in medical treatment. The frequency of this state determines the severity and outcome of the COPD. An essential characteristic of COPD is also a large number of comorbidity, in majority of cases occurred as a consequence of an increased inflammation, oxidative stress and proteolysis of ECM. The most frequent among these diseases are cardiovascular system disease, osteoporosis, dysfunction of skeletal muscles, depression..