Hanyang Med Rev.  2005 Nov;25(4):15-21.

Pathogenesis and Pathophysiology of Chronic Obstructive Pulmonary Disease (COPD)

• Kim WD

Abstract

With the rise in cigarette smoking, COPD has emerged as a critical health problem and unmet medical need worldwide. Much of the information concerning the pathogenesis of COPD comes from studies in experimental animals or in vitro systems. These experimental systems are limited as they differ from human disease in a number of respects. COPD is characterized by chronic inflammation throughout the airways, parenchyma, and pulmonary vasculature. In addition to inflammation, two other processes thought to be important in the pathogenesis of COPD are an imbalance of proteinases and antiproteinases in the lung, and oxidative stress. In addtion to these theories, there are several hypotheses, such as apoptosis theory, ineffective repair theory, role of bacterial and viral infection, genetically determined low CD4+/CD8+ cell ratio and autoimmune theory. Recently it was proposed that a decrease in the histone deacetylase activity due to oxidization by reactive oxygen species from cigarette smoke and inflammatory cells could be associated with enhanced inflammation in COPD. Also, this could be the reason why there is resistance to corticosteroids in COPD. In addition, it was observed that low-dose theophylline markedly induces histone deacetylase transcription. If this is true, the combination of corticosteroids and theophylline could restore delivery of histone deacetylase to the nucleus and decrease inflammation in COPD.

Keyword

Chronic obstructive pulmonary disease; Elastase; Matrix metalloproteinase; Oxidant; Apoptosis; Histone deacetylase

MeSH Terms

Adrenal Cortex Hormones
Animals
Apoptosis
Histone Deacetylases
Humans
Inflammation
Lung
Oxidative Stress
Pancreatic Elastase
Peptide Hydrolases
Pulmonary Disease, Chronic Obstructive*
Reactive Oxygen Species
Smoke
Smoking
Theophylline
Tobacco Products
Adrenal Cortex Hormones
Histone Deacetylases
Pancreatic Elastase
Peptide Hydrolases
Reactive Oxygen Species
Smoke
Theophylline