Superoxide dismutase levels and peak expiratory flow in asthmatic children

Main Article Content

Arie Kurniasih
Madarina Julia
Amalia Setyati


Background Asthma is a chronic inflammatory process which involve variety of cells such as inflammatory mediators, reactive oxygen species (ROS), and cytokines. The inflammatory process would be exacerbated in the presence of oxidative stress. Superoxide dismutase (SOD) is the first important enzyme to protect the respiratory tract against oxidative stress. The decreased of SOD has a correlation with increased of airway obstruction and bronchospasm. Objective To assess for a correlation between superoxide dismutase (SOD) levels and peak expiratory flow, as well as to determine the impact of SOD levels for predicting asthma attacks. Methods We conducted a prospective cohort study at Dr. Sardjito Hospital, Yogyakarta, between February and April 2011 involving asthmatic children aged 5-18 years. Subjects’ serum SOD levels and peak expiratory flow were measured at the same time point. We then performed a prospective study following up on the same subjects to find out if they had a recurrent asthma attack within one month of the tests. We also reassessed their peak expiratory flow one month after blood specimens were obtained. Results Thirty-nine patients were enrolled in this study. There was no significant correlation between SOD level and peak expiratory flow [r=0.289; 95%CI -0.025 to 0.47; P=0.074]. However, older age was significantly associated with higher peak expiratory flow (􀁂=0.5; 95%CI 3.10 to 11.57; P=0.01). Lower levels of SOD increased the risk of asthma attacks in a month following the initial measurements (RR=5.5; 95%CI 1.6 to 18.9; P=0.009). Conclusion Superoxide dismutase (SOD) level is not significantly associated with peak expiratory flow. However, we find a relationship between older age and higher peak expiratory flow and a relationship between lower SOD levels and risk of asthma attacks within one month following the tests.

Article Details

How to Cite
Kurniasih A, Julia M, Setyati A. Superoxide dismutase levels and peak expiratory flow in asthmatic children. PI [Internet]. 30Nov.2016 [cited 26Jun.2019];55(6):309-4. Available from:
Received 2016-02-12
Accepted 2016-02-12
Published 2016-11-30


1. Global Initiative for Asthma (GINA). 2011. Global strategy for asthma management and prevention, National Institutes of Health. [cited October 2012]. Available from:
2. Kartasamita CB. Asma. In: Rahajoe N, Supriyatno B, Setyanto DB, editors. Buku ajar respirologi anak. 2nd ed. Jakarta: Ikatan Dokter Anak Indonesia; 2008. p. 162-213.
3. UKK Pulmonologi PP IDAI. Pedoman nasional asma anak. Proceeding of the Indonesian Pediatric Respiratory Meeting I: focus on asthma; 2003 Aug 8-10; Jakarta, Indonesia.
4. Nadeem, A, Raj HG, Chhabra SK. Increased oxidative stress in acute exacerbations of asthma. J Asthma. 2005;42:45-50.
5. Dweik RA, Comhair SA, Gaston B, Thunnissen FB, Farver C, Thomassen MJ, et al. NO chemical events in the human airway during the immediate and late antigen-induced asthmatic response. Proc Natl Acad Sci. 2001;98:2622-7.
6. Rahman I, MacNee W. Reactive oxygen species from asthma and COPD: basic mechanism and clinical management. London : Elsevier Academic Press; 2002. p. 243-54.
7. Kinnula VL, Crapo JD. Superoxide dismutase in the lung and human lung diseases. Am J Respir Crit Care Med. 2003;167:1600-19.
8. Granot E, Kohen R. Oxidative stress in childhood--in health and disease states. Clin Nutr. 2004;23:3-11.
9. Christofidou-Solomidou M, Muzykantov VR. Antioxidant strategies in respiratory medicine. Treat Respir Med.2006;5:47-78.
10. Misso NL, Brooks-Wildhaber J, Ray S, Vally H, Thompson PJ. Plasma concentrations of dietary and nondietary antioxidants are low in severe asthma. Eur Respir J. 2005;26:257-64.
11. Hanta I, Kuleci S, Canacankatan N, Kocabas A. The oxidant-antioxidant balance in mild asthmatic patients. Lung. 2003;181:347-52.
12. Wood LG, Gibson PG, Garg ML. Biomarkers of lipid peroxidation, airway inflammation and asthma. Eur Respir J. 2003;21:177–86.
13. Comhair SA, Ricci KS, Arroliga M, Lara AR, Dweik RA, Song W, et al. Correlation of systemic superoxide dismutase deficiency to airflow obstruction in asthma. Am J Respir Crit Care Med. 2005;172:306-13.
14. Katsoulis K, Kontakiotis T, Leonardopoulous I, Kotsovili A, Legakis N, Patakas D. Serum total antioxidant status in severe exacerbation of asthma: correlation with the severity of the disease. J Asthma. 2003;40:847–54.
15. Ochs-Balcom HM, Grant BJ, Muti P, Sempos CT, Freudenheim JL, Browne RW, et al. Antioxidants, oxidative stress, and pulmonary function in individuals diagnosed with asthma or COPD. Eur J Clin Nutr. 2006;60:991-9.
16. Uzuner N, Karaman Z, Coker C, Turgut S, Uzuner H, Onvural B. Serum trace element levels in bronchial asthma. Turkish Resp J. 2001;2:10-5.
17. Hellberg J. Factors associated with lung function impairment in children and adults with obstructive lung disease. [Thesis]. [Stockholm, Sweden]: Karolinska Institutet; 2008.
18. Vijayan VK, Reetha AM, Kuppurao KV, Venkatesan P, Thilakavathy S. Pulmonary function in normal south Indian children aged 7 to 19 years. Indian J Chest Dis Allied Sci. 2000;42:147-56.
19. Zhang QL, Zheng JP, Yuan BT, He H, Wang J, An JY, et al. Feasibility and predicted equations of spirometry in Shenzhen preschool children. Zhonghua Er Ke Za Zhi. 2005;43:843-8.
20. Mohammadzadeh I, Gharagozlou M, Fatemil SA. Normal Arie Kurniasih et al: Superoxide dismutase levels and peak expiratory flow in asthma values of peak expiratory flow rate in children from the town of Babol, Iran. Iran J Allergy Asthma Immunol. 2006;5:195-8.
21. Manjunath CB, Kotinatot SC, Babu M. Peak expiratory flow rate in healthy rural school going children (5-16 years) of Bellur region for construction of nomogram. J Clin Diagn Res. 2013;7:2844-6.
22. Psarras S, Caramori G, Contoli M, Papadopoulos N, Papi A. Oxidants in asthma and in chronic obstructive pulmonary disease (COPD). Curr Pharm Des. 2005;11:2053-62.
23. Sackesen C, Ercan H, Dizdar E, Soyer O, Gumus P, Tosun BN, et al. A comprehensive evaluation of the enzymatic and nonenzymatic antioxidant systems in childhood asthma. J Allergy Clin Immunol. 2008;122:78-85.
24. Fenech AG, Ellul-Micallef R. Selenium, glutathione peroxidase and superoxide dismutase in maltese asthmatic patients: effect of glucocorticoid administration. Pulm Pharmacol Ther. 1998;11:301-8.
25. Fitzpatrick AM, Teague WG, Holguin F, Yeh M, Brown LA. Airway glutathione homeostasis is altered in children with severe asthma: evidence for oxidant stress. J Allergy Clin Immunol. 2009;123:146-52.