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Why does the lung hyperinflate?

Gary T Ferguson1

  • 1Pulmonary Research Institute of Southeast Michigan, Livonia, Michigan 48152, USA. garytferguson@msn.com

Proceedings of the American Thoracic Society
|March 28, 2006
PubMed
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Dynamic hyperinflation in chronic obstructive pulmonary disease (COPD) occurs when air trapping exceeds exhalation capacity. Reversible dynamic hyperinflation can be treated with long-acting bronchodilators, improving patient symptoms.

Area of Science:

  • Pulmonary Medicine
  • Respiratory Physiology

Background:

  • Chronic obstructive pulmonary disease (COPD) is frequently associated with lung hyperinflation.
  • Lung hyperinflation negatively impacts breathing and functional capacity in COPD patients.
  • Lung volume reduction surgery demonstrates symptom improvement, underscoring hyperinflation's significance.

Purpose of the Study:

  • To elucidate the mechanisms of lung hyperinflation in COPD.
  • To explore how understanding these mechanisms can guide treatment strategies.
  • To investigate the potential for interventions targeting dynamic hyperinflation.

Main Methods:

  • Distinguished between static and dynamic hyperinflation mechanisms.
  • Analyzed the role of lung elasticity and chest wall recoil in static hyperinflation.

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  • Examined air trapping due to expiratory airflow limitation and insufficient exhalation time in dynamic hyperinflation.

    • Main Results:

    • Static hyperinflation results from decreased lung elasticity (emphysema), leading to higher resting lung volumes.
    • Dynamic hyperinflation is common, caused by air trapping from incomplete exhalation, exacerbated by increased respiratory demand or exacerbations.
    • Long-acting bronchodilators, like tiotropium, can reduce dynamic hyperinflation, mimicking lung volume reduction surgery outcomes.

    Conclusions:

    • Both static and dynamic mechanisms contribute to lung hyperinflation in COPD.
    • Dynamic hyperinflation is often reversible and presents a therapeutic target.
    • The efficacy of bronchodilators in managing COPD hyperinflation may require reassessment of current evaluation methods.