Author Affiliations

1. Division of Pulmonary and Critical Care, Johns Hopkins University, Baltimore, Maryland, United States
2. Division of Cardiology, Johns Hopkins University, Baltimore, Maryland, United States

Address correspondence to:

Obiageli Offor, MD, MPH
Division of Pulmonary and Critical Care
Johns Hopkins University
Baltimore, Maryland
Email: ooffor1@jhmi.edu

Abstract

Background: Individuals with chronic obstructive pulmonary disease (COPD) are disproportionately affected by social determinants of health that have been associated with worse respiratory outcomes. This study evaluates the association of perceived stress with respiratory outcomes and distinct biological mechanisms among former smokers with COPD.

Methods: Participants were assessed in an observational study at baseline, 3-months, and 6-months. Questionnaires assessed perceived stress (Perceived Stress Scale, [PSS]), respiratory symptoms, and incidence of COPD exacerbations. Generalized linear mixed models evaluated the association of PSS score with COPD outcomes and biomarkers of platelet activation (urine 11-dehydro-thromboxane B2 [11dTxB2]), oxidative stress (urine thiobarbituric acid reactive substances [TBARS], 8- hydroxydeoxyguanosine, and 8-isoprostane), and inflammation.

Results: Among 99 participants, the median PSS score was 13 (interquartile range 8–18) across all visits. Compared with low perceived stress (PSS 0–13), moderate (PSS 14–26) and high perceived stress (PSS 27–40) were associated with worse respiratory health status and respiratory-related quality of life, with point estimates for high perceived stress exceeding clinically important differences. Only high PSS was associated with increased moderate/severe exacerbations (odds ratio 4.15, 95% confidence interval [CI]: 1.28–13.47). Compared to low stress, high stress was associated with lower TBARS (β=-25.5%, 95%CI: -43.8– -1.2%) and higher 8-isoprostane (β=40.1%, 95%CI: 11.5–76.0%). Among individuals with mild-moderate COPD, compared to low stress, moderate (β=20.1%, 95%CI: 3.1–40.0%) and high (β=52.9%, 95%CI: 22.1–91.6%) stress were associated with higher 11dTxB2.

Conclusions: Among former smokers with COPD, higher perceived stress is associated with worse respiratory outcomes. Platelet activation and oxidative stress may be biological pathways through which perceived stress plays a role in COPD.

Citation

Citation: Offor O, Eakin MN, Woo H, et al. Perceived stress is associated with health outcomes, platelet activation, and oxidative stress in COPD. J COPD F. 2025; 12(2): 98-108. doi: http://doi.org/10.15326/jcopdf.12.2.2024.0561

Keywords

COPD, oxidative stress, outcomes, platelet activation, perceived stress

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Author Affiliations

1. Department of Respiratory Medicine, Hannover Medical School, Member of German Centre for Lung Research (DZL), Hannover, Germany; Department of Genetics and Clinical Immunology, National Institute of Tuberculosis and Lung Diseases, Warsaw, Poland

Address correspondence to:

Sabina Janciauskiene, PharmD, PhD
Phone: +49 511 532 7297
Email: janciauskiene.sabina@mh-hannover.de

Abstract

Reactive oxygen and nitrogen species can be generated endogenously (by mitochondria, peroxisomes, and phagocytic cells) and exogenously (by pollutions, UV exposure, xenobiotic compounds, and cigarette smoke). The negative effects of free radicals are neutralized by antioxidant molecules synthesized in our body, like glutathione, uric acid, or ubiquinone, and those obtained from the diet, such as vitamins C, E, and A, and flavonoids. Different microelements like selenium and zinc have no antioxidant action themselves but are required for the activity of many antioxidant enzymes. Furthermore, circulating blood proteins are suggested to account for more than 50% of the combined antioxidant effects of urate, ascorbate, and vitamin E. Antioxidants together constitute a mutually supportive defense against reactive oxygen and nitrogen species to maintain the oxidant/antioxidant balance. This article outlines the oxidative and anti-oxidative molecules involved in the pathogenesis of chronic obstructive lung disease. The role of albumin and alpha-1 antitrypsin in antioxidant defense is also discussed.

Citation

Citation: Janciauskiene S. The beneficial effects of antioxidants in health and diseases. J COPD F. 2020; 7(3): 182-202. doi: http://doi.org/10.15326/jcopdf.7.3.2019.0152

Keywords

inflammation, alpha-1 antitrypsin, oxidative stress, reactive oxygen species, antioxidants, lung disease

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Author Affiliations

1. Departments of Anesthesiology and Medicine, Columbia University Medical Center, New York, New York
2. Department of Medicine, Queen Elizabeth Hospital, Birmingham, United Kingdom

Address correspondence to:

Monica Goldklang, MD
Columbia University Medical Center
630 West 168th Street, P&S 12-402
New York, NY 10032
Email: mpg2124@cumc.columbia.edu

Abstract

This article serves as a CME-available, enduring material summary of the following COPD9_USA presentations:

• “Overview of Lung Injury in COPD: Types and Key Questions” Presenter: Caroline Owen, MD, PhD
• Emphysema as a Disease of Deficient Tissue Repair/Maintenance” Presenter: Rubin Tuder, MD

Citation

Citation: Goldklang M, Stockley R. Pathophysiology of emphysema and implications. J COPD F. 2016; 3(1): 454-458. doi: http://doi.org/10.15326/jcopdf.3.1.2015.0175

Keywords

emphysema, proteinases, oxidative stress, alveolar septal cell death, mammalian target of rapamycin, mTOR, vascular endothelial growth factor, VEGF

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Click to read Pathophysiology of Emphysema and Implications

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