Chronic Obstructive Pulmonary Disease COPD

The generation of oxygen free radicals by activated inflammatory cells produces many of the pathophys-iological changes associated with COPD. Common examples of COPD are asthma and bronchitis, each of which affects large numbers of children and adults. Antioxidant nutrients have therefore been suggested to play a role in the prevention and treatment of these conditions. A number of studies have demonstrated a beneficial effect of fruit and vegetable intake on lung function. For example, regular consumption of fresh fruit rich in vitamin C (citrus fruits and kiwi) has been found to have a beneficial effect on reducing wheezing and coughs in children.

Vitamin C is the major antioxidant present in extracellular fluid lining the lung, and intake in the general population has been inversely correlated with the incidence of asthma, bronchitis, and wheezing and with pulmonary problems. Although some trials have shown high-dose supplementation (1-2g/day) to improve symptoms of asthma in adults and protect against airway responsiveness to viral infections, allergens, and irritants, this effect has been attributed to the antihistaminic action of the vitamin rather than to any antioxidant effect. The results of these trials have also been inconsistent, and a Cochrane review of eight RCTs concluded that there is insufficient evidence to recommend a specific role for the vitamin in the treatment of asthma. However, a need for further trials to address the question of the effectiveness of vitamin C in asthmatic children was highlighted.

Other dietary antioxidants have been positively associated with lung function in cohort studies but the findings of clinical trials have been mixed. In a study of 158 children with moderate to severe asthma, supplementation with vitamin E (50mg/day) and vitamin C (250mg/day) led to some improvement in lung function following ozone exposure. However, the much larger ATBC trial found no benefit from supplementation with a-tocopherol (50mg/day) and ^-carotene (20mg/day) on symptoms of COPD, despite the fact that those with high dietary intakes and blood levels of these vitamins at baseline had a lower prevalence of chronic bronchitis and dyspnea. A small trial investigating the effects of selenium supplementation in asthmatics found that those receiving the supplements experienced a significant increase in glutathione peroxidase levels and reported improvement in their asthma symptoms. However, this improvement could not be validated by significant changes in the separate clinical parameters of lung function and airway hyperresponsiveness. Therefore, there is little evidence to support the role of other nutrients in COPD treatment.

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