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Alveolar macrophages derived from circulating monocytes recruited into the lungs by monocyte chemotactic factors produced by lung cells are increased 20-fold in COPD patients and release ROS as superoxide anions and hydrogen peroxide (102)

This data comes from animal models and may not translate directly to human physiology

Because absorption is limited, raising serum B12 with pills is a gradual, cumulative process that can take weeks or months of consistent daily use

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doi: 10.1067/mtc.2001.115699