The Effects of Allopurinol on Glutathione Sulfhydryl (GSH) Serum Level, %FEV1, Six Minute Walking Test, and CAT Score of Chronis Obstructive Pulmonary Disease Patients
Abstract
Introduction: Stress oxidative in chronic obstructive pulmonary disease (COPD) impaired striated muscle thus worsening COPD clinical symptoms. Allopurinol as antioxidant reduces stress oxidative in COPD so it can improve exercise capacity and clinical symptoms of COPD patients. The aims of this study were to analyze the effect of allopurinol on glutathione sulfhydryl (GSH) serum level, %FEV1 , six-minute walking test (6MWT), and COPD assessment test (CAT) score of COPD group C and D patients.
Methods: This was a pre and post test group clinical trials held in pulmonology outpatient clinic in Dr. Moewardi general hospital, Surakarta from January to February 2018 using purposive sampling. The COPD group C and D patients were categorized as intervention group which received allopurinol 300 mg/day for four weeks and a control group which did not receive allopurinol. Glutathione sulfhydryl serum level, %FEV1, 6MWT, and CAT score were measured at baseline and after four weeks in both groups.
Results: A total of 37 stable COPD group C and D patients were included in this study. The intervention group showed decreased of GSH level (52.58 ± 38.39) µg/ml and CAT score (10.37 ± 4.46) which were statistically significant compared to control group (p<0,05) while decreased of %FEV1 in intervention group (6.91 ± 10.60) and control group (8.43 ± 11.26) were not significant statistically (p=0.94). The intervention group also showed a significant increase of 6MWT (p=0.005) while the control group showed no significant increase (p=0.109); however, the 6MWT differences in both groups were not significant with p=0.057.
Conclusion: Allopurinol decreased GSH serum level, did not influence %FEV1 , increased 6MWT, and decreased CAT score of stable COPD group C and D patients.
Keywords: COPD, allopurinol, GSH, %FEV1, 6MWT, CAT
References
[1] GOLD 2017 Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease Global Initiative for Chronic Obstructive Lung Disease Inc. 2017 1-123
[2] Senior RM, Pierce RA, Atkinson J 2015 Chronic obstructive pulmonary disease: epidemiology, pathophysiology, pathogenesis, and α1-antitrypsin deficiency Fishman’s pulmonary diseases and disorders. Vol 5, ed Grippi MA, Elias JA, Fishman JA, Kotloff RM, Pack AI, Senior R (New York: McGraw-Hill Education) chapter 40 pp 613-45
[3] Amin M, Yunus F, Antariksa B, Djajalaksana S, Wiyono W 2016 PPOK diagnosis dan penatalaksanaan. Vol 1 ( Jakarta: Penerbit Universitas Indonesia) p 1-111
[4] Barnes PJ 2013 New anti-inflammatory targets for chronic obstructive pulmonary disease Nat Rev Drug Discov. 12 543-59
[5] Rahman I 2012 Pharmacological antioxidant strategies as therapeutic interventions for COPD Biochim Biophys Acta. 1822 714-28
[6] Pirabbasi E and Cheragi M. 2012 Antioxidant supplementation among COPD: is it necessary? Pakistan J Nutr. 11 501-6
[7] Kirkham PA and Barnes PJ. 2013 Oxidative stress in COPD Chest. 144 266-73
[8] Pouwels SD, Heijink IH, Hacken NHT, Vandenabeele P, Krysko DV, Nawijn MC, van Oosterhout AJM 2014 DAMPs activating innate and adaptive immune responses in COPD Mucosal Immunology. 7 1-12
[9] Heunks LMA and Dekhuijzen PNR 2000 Respiratory muscle function and free radicals: from cell to COPD Thorax. 55 704-16
[10] Ryan MJ, Jackson JR, Hao Y, Leonard SS, Alway SE 2011 Inhibition of xanthine oxidase reduces oxidative stress and improves skeletal muscle function in response to electrically stimulated isometric contractions in aged mice Free Radic Biol Med. 51 38-52
[11] Macnee W, Vestbo J, Agusti A 2016 COPD: pathogenesis and natural history Murray & Nadel’s textbook of respiratory medicine. Vol 6,ed Broaddus VC, Mason RJ, Ernst JD, King TE, Lazarus RC, Murray JF, Nadel JA, Slutsky AS (Philadelphia: Elsevier Saunders) chapter 43 pp 751-89
[12] Ichinose M, Sugiura H, Yamagata S, Koarai A, Tomaki M, Ogawa H, Komaki Y, Barnes PJ, Shirato K, Hattori T 2003 Xanthine oxidase inhibition reduces reactive nitrogen species production in COPD airways Eur Respir J. 22 457-61
[13] Raharjo A 2017 Thesis Pengaruh latihan harmonika pada kapasitas inspirasi, gejala sesak napas, kapasitas latihan, dan kualitas hidup penderita PPOK (Surakarta: Departement of Pulmonology and Respiratory Medicine Medical Faculty: Universitas Sebelas Maret)
[14] Widyastuti K 2017 Thesis Pengaruh exercise berjalan berbasis pedometer dan standar terhadap aktivitas fisik, gejala sesak napas, kapasitas exercise, dan kualitas hidup penderita PPOK stabil. (Surakarta: Departement of Pulmonology and Respiratory Medicine Medical Faculty: Universitas Sebelas Maret)
[15] Morris D, Khurasany M, Nguyen T, Kim J, Guilford F, Mehta R, Gray D, Saviola B, Venketaraman V 2013 Glutathione and infection Biochim Biophys Acta - Gen Subj. 1830 3329-49
[16] Hyatt R 2014 Spirometry: dynamic lung volumes Interpretation of pulmonary function test: a practical guide. Vol 4, ed Hyatt RE, Scanlon PD, Nakamura M (Philadelphia: Walters Kluwer Health) chapter 2 pp. 4-22
[17] Hellebrandová L, Chlumský J, Vostatek P, Novák D, Rýznarová Z, Bunc V 2016 Airflow limitation is accompanied by diaphragm dysfunction Physiol Res. 65 469-79
[18] Rochester CL, Vogiatzis I, Holland AE, Lareau SC, Marciniuk DD, Spruit M 2015 An official American Thoracic Society/European Respiratory Society policy statement: enhancing implementation, use, and delivery of pulmonary rehabilitation Am J Respir Crit Care Med 192 1373-86
[19] Holland AE, et al 2014 An official European respiratory society/American thoracic society technical standard: field walking tests in chronic respiratory disease Eur Respir J. 44 1428-46
[20] Enright P 2003 The Six-Minute Walk Test Respir Care. 48 783-5
[21] Karloh M, Mayer AF, Maurici R, Pizzichini MMM, Jones PW, Pizzichini E 2016 The COPD assessment test: What do we know so far? A systematic review and metaanalysis about clinical outcomes prediction and classification of patients into gold stages Chest. 149 413-425
[22] Smid DE, Franssen FME, Houben-Wilke S, Vanfleteren LEGW, Janssen DJA, Wouters EFM, Spruit MA 2017 Responsiveness and MCID estimates for CAT, CCQ, and HADS in patients with COPD undergoing pulmonary rehabilitation: a prospective analysis J Am Med Dir Assoc. 18 53-80