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COPD/emphysema: The vascular story.
Norbert F Voelkel1, Jose Gomez-Arroyo, Shiro Mizuno
1Department of Internal Medicine, Victoria Johnson Laboratory for Obstructive Lung Disease Research, Virginia Commonwealth University, Richmond, Virginia, USA.
Pulmonary Circulation
|December 6, 2011
Summary
Chronic lung diseases like emphysema involve lung vessels, with microvascular damage contributing to disease progression. A "sick lung circulation" may better explain cardiac issues in COPD than right heart afterload.
Area of Science:
- Pulmonary Medicine
- Cardiovascular Research
- Pathobiology
Background:
- Chronic and progressive lung diseases frequently involve pulmonary vasculature.
- Microvascular abnormalities and endothelial cell death are implicated in emphysema pathobiology.
- Vascular Endothelial Growth Factor (VEGF) signaling is crucial for lung vessel maintenance and is compromised in emphysema.
Purpose of the Study:
- To review evidence supporting the role of lung vasculature in chronic lung diseases.
- To propose that "sick lung circulation" is a better explanation for cardiac abnormalities in COPD than right heart afterload.
- To explore the complex mechanisms underlying pulmonary hypertension in COPD.
Main Methods:
- Review of published data on lung diseases, vasculature, and emphysema.
- Analysis of the role of Vascular Endothelial Growth Factor (VEGF) signaling.
- Consideration of cigarette smoke's independent effects on lung vessels.
- Evaluation of mechanisms contributing to pulmonary hypertension.
Main Results:
- Many chronic lung diseases involve lung vessels, with microvascular damage contributing to emphysema.
- Cigarette smoke damages lung vessels independently of vascular tone.
- Pulmonary hypertension in COPD involves vessel loss, thrombosis, and endothelial dysfunction.
- "Sick lung circulation" may explain cardiac issues in COPD more effectively than right heart afterload.
Conclusions:
- Pulmonary vascular damage is a key component in the pathobiology of emphysema and other chronic lung diseases.
- Understanding pulmonary hypertension in COPD requires considering multiple factors including vessel loss and endothelial dysfunction.
- Hemodynamic assessment during exercise is necessary to evaluate the functional significance of pulmonary hypertension in COPD.
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