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Background: Chronic obstructive pulmonary disease (COPD) is a major cause of respiratory morbidity and mortality worldwide. One of the main hypotheses concerning the pathogenesis of emphysema, a key cause of morbidity and mortality in COPD, is the protease antiprotease imbalance. Irreversible airflow obstruction in Chronic Obstructive Pulmonary Disease (COPD) is thought to result from airway remodeling associated with aberrant inflammation.This study examined changes in sputum as regards MMP-9, TIMP-1 and levels of inflammatory cells in COPD patients compared with sputum of healthy smokers and non smokers.Methods: Forty patients were included in this study. FEV1 before and after salbutamol inhalation, MMP-9, TIMP-1 and inflammatory cell count in the sputum of COPD patients, healthy smokers and non-smokers were investigated.Results: MMP-9 was significantly increased in both COPD patients (194.4 ± 100.6), and healthy smokers (104.5 ± 42.1) compared with healthy non smokers (34.5 ± 36.1). TIMP-1 was increased more in healthy non-smokers (192.7 ± 37.7) than COPD patients (115 ± 55.5) and healthy smokers (145.3 ± 35.1). MMP-9/TIMP-1 was high in COPD patients (1.7 ± 0.9) and healthy smokers (0.7 ± 0.3) compared with healthy non smokers (0.2 ± 0.2). Mean sputum total leucocytic count (TLC) was highly statistically significantly different between the three groups. COPD group showed the highest means value while non smokers group showed the lowest one.Conclusions: COPD is characterized by an imbalance between MMP-9 and TIMP-1 which may play an important role in the pathogenesis of tissue remodeling and airway obstruction.

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Background: Asthma and COPD are characterized by chronic airway inflammation that results in chronic airway obstruction which is reversible in asthma and non-reversible or partially reversible in COPD. The differential diagnosis between reversible or irreversible airflow obstruction due to asthma or COPD is important in clinical practice because the prognosis and the response to treatment of the two diseases are different. Nitric oxide (NO) is produced by many cells within the respiratory tract. Endogenous NO may play an important signaling role in the physiological control of airway function and in the pathophysiology of airway diseases. Measurement of airway inflammation by means of FENO may be useful and convenient for asthma diagnosis, particularly when bronchial challenges and/or spirometric maneuvers cannot be correctly performed. The increase in the percentage of peripheral blood and sputum eosinophils was found in patients with asthma that correlated with the clinical severity of asthma and pulmonary function. Elevated levels of C-reactive protein (CRP) are established in COPD but, in asthma, the results have been inconsistent. The aim of the present study was to evaluate differences in local (airway) and systemic inflammatory markers among primary care patients with asthma and COPD using simple, rapid and easy to do tests.Subjects and methods: One hundred and fifty patients and thirty control subjects were included in this study. They were divided into three groups, ninety asthmatic patients diagnosed clinically and physiologically as reversible airway obstruction (group I). Sixty COPD patients diagnosed by clinical, physiological and laboratory tests to have irreversible or partially reversible airway obstruction (group II). The third group is the control group with no airway obstruction (NAO) including thirty subjects. Pulmonary function tests, FENO, hs-CRP, blood and sputum eosinophil percentages were done to all subjects.Results: FENO was positively correlated with all inflammatory markers in the asthmatic group with highly significant differences (p 6 .001) and negatively correlated with age, BMI and PFTs. In

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