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COPD exacerbations . 3: Pathophysiology.

D E O'Donnell1, C M Parker

  • 1Division of Respiratory and Critical Care Medicine, Department of Medicine, Queen's University,102 Stuart Street, Kingston, Ontario, Canada K7L 2V6. odonnell@post.queensu.ca

Thorax
|March 28, 2006
PubMed
Summary

Understanding the physiological mechanisms of chronic obstructive pulmonary disease (COPD) exacerbations is key to effective management. This review details the natural history and pathophysiology of COPD exacerbations, focusing on expiratory flow limitation.

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Area of Science:

  • Pulmonary Medicine
  • Respiratory Physiology

Background:

  • Exacerbations of chronic obstructive pulmonary disease (COPD) significantly increase morbidity and mortality.
  • The clinical presentation of COPD exacerbations is highly variable, reflecting heterogeneous pathophysiological mechanisms.

Purpose of the Study:

  • To review the natural history of COPD exacerbations using physiological measurements.
  • To discuss the pathophysiology of stable COPD and the impact of acute expiratory flow limitation.

Main Methods:

  • Review of clinical studies incorporating physiological measurements.
  • Analysis of pathophysiological mechanisms in stable and exacerbated COPD.

Main Results:

  • Severe COPD exacerbations with respiratory failure involve derangements in ventilatory mechanics, muscle function, and gas exchange.

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  • Critical expiratory flow limitation and dynamic lung hyperinflation are key deleterious events in severe exacerbations.

    • Conclusions:

    • Understanding the physiological events leading to ventilatory insufficiency is crucial for managing COPD exacerbations.
    • Further validation is needed for the proposed mechanisms in less severe COPD exacerbations.