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activated inflammatory cells in the lungs can release endogenous oxides, 53 when these substances exceed the body’s antioxidant capacity, the imbalance between oxidation and antioxidant causes oxidative stress, resulting in airway epithelial damage, reduced ciliary movement and release of NE, which in turn causes cellular dysfunction or apoptosis, inflammatory response, accumulation of mucus substances and their easy elimination, extracellular matrix destruction, protease/anti-protease imbalance, etc., leading to the development and progression of COPD and increased comorbidity

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