COPD, also known as chronic obstructive pulmonary disease, is a serious respiratory disease that causes patients to be unable to restore normal air circulation and is accompanied by significant wheezing symptoms. Acute exacerbation of COPD (AECOPD) is one of the three leading causes of death globally with high prevalence, high burden of disease, and high mortality. AECOPD is a severe respiratory disease characterized by acute exacerbation and requires immediate intervention. Oxidative stress is the main cause of morbidity in COPD, therefore, antioxidant therapy is particularly important for patients with AECOPD.
Relationship between
oxidative stress and chronic obstructive pulmonary disease
Oxidative stress refers to the imbalance between the production of reactive oxygen species (ROS) and the antioxidant defense system in vivo. ROS is composed of superoxide anion, hydrogen peroxide and hydroxyl radicals, which can be produced by oxidation reactions. When the concentration of ROS increases, they can erode proteins, lipids and genes, destroy the normal structure of cells, and affect the synthesis of proteins, and ultimately induce the emergence of various diseases.
The elevated level of ROS in
patients with COPD mainly comes from both exogenous and endogenous aspects. ROS is an external factor, which is usually caused by inhaled harmful gases or environmental pollutants. For example, smoke, automobile exhaust and dust in the workplace. Endogenous ROS mainly originated from mitochondrial dysfunction, peroxisome and NADPH oxidase system.
Application
of Antioxidants in the Treatment of Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease
Glutathione Valley
Glutathione is considered a powerful antioxidant, and its structure includes glycine, cysteine, and glutamic acid. This peptide can interact with ROS and act as a complement to various enzymes, which plays an important role in protecting the body from oxidative damage, activating protein thiol redox reactions and maintaining the stability of the redox system. According to the latest research, serum glutathione concentrations in patients with AECOPD are significantly reduced, which means that increasing glutathione intake will have a significant therapeutic effect.
N-acetyl
cysteine (NAC)
NAC can be considered as a key step in the synthesis of cysteine, which can not only effectively improve blood circulation, but also activate the expression of Nrf gene, reduce the production of mucin in airway epithelial cells, effectively eliminate oxygen free radicals, and effectively prevent the degradation of proteins, thus having a significant anti-aging effect. According to the latest research, the use of the correct NAC therapy significantly reduces the exacerbation of symptoms in patients with AECOPD.
Other antioxidants
In addition to glutathione and NAC, other antioxidants have shown potential efficacy in the treatment of patients with COPD exacerbations. For example, vitamins A, C, E, alpha/beta-carotene and other nutrients can help us build a strong oxidative resistance mechanism to effectively resist oxidative stress and maintain good health. However, it is not clear whether vitamin supplementation is beneficial for COPD.
Studies have shown that both uric acid and bilirubin can play an anti-aging role. Among them, uric acid can inhibit the production of free radicals, especially for those with chronic respiratory diseases, the prognosis is not optimistic. Bilirubin is considered to have a protective effect on the progression of COPD, but the results are not consistent.
Antioxidant therapy: clinical applications and challenges
Antioxidant therapy in patients with AECOPD is mainly achieved through drug therapy, such as the use of bronchodilators, glucocorticoids and antibiotics. However, antioxidant therapy also faces some challenges. For example, the choice and dosage of antioxidants need to be individualized because of differences in the degree of oxidative stress and antioxidant defense in different patients. In addition, the safety and long-term efficacy of antioxidants need to be further evaluated.
Conclusion
Oxidative stress is an important factor in the mechanism of COPD morbidity, and the application of antioxidant therapy in patients with AECOPD has broad prospects. Antioxidants such as glutathione and NAC can improve the symptoms and prognosis of patients by increasing the level of antioxidants in the lung and inhibiting the production and damage of ROS. However, the specific protocols, safety and long-term efficacy of antioxidant therapy still need to be further studied and improved. Antioxidant therapy is expected to become an important part of the comprehensive treatment of AECOPD patients in the future.