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In order to understand how COPD can be stopped and/or reversed, it is critical to understand the interactions between protease-antiprotease imbalance, apoptosis/autophagy and oxidative stress in tissue destruction 17 These processes can be amplified by ceramides, endogenous mediators activated by cigarette smoke and VEGF receptor blockade, initiating pulmonary cell apoptosis, protease/antiprotease balance and oxidative stress, 18 ultimately resulting in airspace enlargement

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