Pathophysiology of chronic obstructive pulmonary disease

The prevalence of COPD has increased as mortality from the two organ systems affected by the same risk factors of smoking, heart attacks and strokes, has decreased. Once diagnosed, COPD is progressive and may lead to disability, usually due to dyspnea, at a relatively early age (60 to 80 years of age). COPD is usually caused by destruction of the lung parenchyma or by disease affecting the airways. In most patients both processes exist simultaneously. Less often recognized is the fact that the disease does not affect all portions of the lung alike, which causes different physiologic behaviors in different parts of the lung. This article integrates the pathologic changes of COPD with the known adaptive and maladaptive consequences of those changes. An understanding of these changes should result in an increased capacity to comprehend the different therapeutic strategies that have been developed to decrease the symptoms and improve the well-being of patients with COPD.