The cellular and molecular mechanisms underlying AECOPD are unclear, but there is an increase in neutrophils and concentrations of IL-6, IL-8, TNF-α and LTB4 in sputum during an exacerbation [78,79], and patients who have frequent exacerbations have higher levels of IL-6 and lower concentrations of SLPI, even when COPD is stable [80,81]. This evidence concerns the gene TNF and chronic obstructive pulmonary disease.