Low levels of VEGF have been observed in sputum from patients with COPD, and VEGF sputum levels were inversely correlated with airflow limitation assessed as forced expiratory volume in 1 second.36 In a recent study, it has been shown that hypoglycemia reduces VEGF-A production, which specifically acts on endothelial cells and has various effects, including endothelial cell growth and inhibiting apoptosis.37 The other possible mechanism is that hypoglycemia increases platelet aggregation and fibrinogen formation,38 and this may accelerate vascular compromise in the lung. This evidence concerns the gene VEGFA and chronic obstructive pulmonary disease.