Pathophysiology of Chronic Obstructive Pulmonary Disease

Article information

J Korean Med Assoc. 2006;49(4):305-312
Publication date (electronic) : 2006 April 30
doi : https://doi.org/10.5124/jkma.2006.49.4.305
Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Korea. sdlee@amc.seoul.kr

Abstract

Chronic obstructive pulmonary disease (COPD) is a chronic progressive disease that is characterized by irreversible airflow limitation with a partially reversible component. The pathologic abnormalities of COPD are associated with lung inflammation, an imbalance of proteinases and antiproteinases, and oxidative stress that are induced by noxious particles and gases in susceptible individuals. The physiologic changes of COPD are mucus hypersecretion, ciliary dysfunction, airflow limitation, pulmonary hyperinflation, gas exchange abnormalities, pulmonary hypertension, cor pulmonale, and systemic effects. The airflow limitation results principally from an increase in the resistance of the small conducting airways and a decrease in the pulmonary elastic recoil due to emphysematous lung destruction. This article provides a general overview of the pathophysiology of COPD.

References

1. Pauwels RA, Buist AS, Calverley PMA, Jenkins CR, Hurd SS. Global strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease. NHLBI/WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD) Workshop summary. Am J Respir Crit Care Med 2001. 1631256–1276.
2. Mullen JB, Wright JL, Wiggs BR, Pare PD, Hogg JC. Reassessment of inflammation of airways in chronic bronchitis. BMJ (Clin Res Ed) 1985. 2911235–1239.
3. Cosio M, Ghezzo H, Hogg JC, Corbin R, Loveland M, Dosman J, et al. The relations between structural changes in small airways and pulmonary-function tests. N Engl J Med 1978. 2981277–1281.
4. Matsuba K, Thurlbeck WM. The number and dimensions of small airways in emphysematous lungs. Am J Pathol 1972. 67265–275.
5. Hogg JC, Macklem PT, Thurlbeck WM. Site and nature of airway obstruction in chronic obstructive lung disease. N Engl J Med 1968. 2781355–1360.
6. Kuwano K, Bosken CH, Pare PD, Bai TR, Wiggs BR, Hogg JC. Small airways dimensions in asthma and in chronic obstructive pulmonary disease. Am Rev Respir Dis 1993. 1481220–1225.
7. Matsuba K, Wright JL, Wiggs BR, Pare PD, Hogg JC. The changes in airways structure associated with reduced forced expiratory volume in one second. Eur Respir J 1989. 2834–839.
8. Dayman H. Mechanics of airflow in health and emphysema. J Clin Invest 1951. 301175–1190.
9. Butler J, Caro CG, Alcala R, Dubois AB. Physiological factors affecting respiratory resistance in normal subjects and in patients with obstructive airways disease. J Clin Invest 1960. 39584–591.
10. Mead J, Turner JM, Macklem PT, Little JB. Significance of the relationship between lung recoil and maximum expiratory flow. J Appl Physiol 1967. 2295–108.
11. Burnett D, Stockley RA. Serum and sputum alpha 2 macroglobulin in patients with chronic obstructive airways disease. Thorax 1981. 36512–516.
12. Lane DJ, Howell JB, Giblin B. Relation between airways obstruction and CO2 tension in chronic obstructive airways disease. BMJ 1968. 3707–709.
13. Rodriguez-Roisin R, MacNee W. Pathophysiology of chronic obstructive pulmonary disease. In : Postma DS, Siafakas MN, eds. Pathophysiology of chronic Management of chronic obstructive pulmonary disease. European Respiratory Monograph 1998. 3107–106.
14. McLean A, Warren PM, Gillooly M, MacNee W, Lamb D. Microscopic and macroscopic measurements of emphysema: relation to carbon monoxide gas transfer. Thorax 1992. 47144–149.
15. Barbera JA, Riverola A, Roca J, Ramirez J, Wagner PD, Ros D, et al. Pulmonary vascular abnormalities and ventilation-perfusion relationships in mild chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1994. 149423–429.
16. MacNee W. Pathophysiology of cor pulmonale in chronic obstructive pulmonary disease. Part two. Am J Respir Crit Care Med 1994. 1501158–1168.
17. Knighton DR, Hunt TK, Scheuenstuhl H, Halliday BJ, Werb Z, Banda MJ. Oxygen tension regulates the expression of angiogenesis factor by macrophages. Science 1983. 2211283–1285.
18. Biernacki W, Flenley DC, Muir AL, MacNee W. Pulmonary hypertension and right ventricular function in patients with COPD. Chest 1988. 941169–1175.
19. Saetta M, Di Stefano A, Maestrelli P, Turato G, Ruggieri MP, Roggeri A, et al. Airway eosinophilia in chronic bronchitis during exacerbations. Am J Respir Crit Care Med 1994. 1501646–1652.
20. Saetta M, Di Stefano A, Maestrelli P, Turato G, Mapp CE, Pieno M, et al. Airway eosinophilia and expression of interleukin-5 protein in asthma and in exacerbations of chronic bronchitis. Clin Exp Allergy 1996. 26766–774.
21. Pizzichini MM, Pizzichini E, Efthimiadis A, Clelland L, Mahony JB, Dolovich J, et al. Markers of inflammation in induced sputum in acute bronchitis caused by Chlamydia pneumoniae. Thorax 1997. 52929–931. discussion 926 - 7.
22. Pizzichini E, Pizzichini MM, Gibson P, Parameswaran K, Gleich GJ, Berman L, et al. Sputum eosinophilia predicts benefit from prednisone in smokers with chronic obstructive bronchitis. Am J Respir Crit Care Med 1998. 1581511–1517.
23. Maestrelli P, Saetta M, Di Stefano A, Calcagni PG, Turato G, Ruggieri MP, et al. Comparison of leukocyte counts in sputum, bronchial biopsies, and bronchoalveolar lavage. Am J Respir Crit Care Med 1995. 1521926–1931.
24. Turner MO, Hussack P, Sears MR, Dolovich J, Hargreave FE. Exacerbations of asthma without sputum eosinophilia. Thorax 1995. 501057–1061.
25. Fahy JV, Kim KW, Liu J, Boushey HA. Prominent neutrophilic inflammation in sputum from subjects with asthma exacerbation. J Allergy Clin Immunol 1995. 95843–852.
26. Barbera JA, Roca J, Ferrer A, Felez MA, Diaz O, Roger N, et al. Mechanisms of worsening gas exchange during acute exacerbations of chronic obstructive pulmonary disease. Eur Respir J 1997. 101285–1291.
27. Seemungal TA, Donaldson GC, Bhowmik A, Jeffries DJ, Wedzicha JA. Time course and recovery of exacerbations in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2000. 1611608–1613.
28. Schmidt GA, Hall JB. Acute or chronic respiratory failure. Assessment and management of patients with COPD in the emergency setting. JAMA 1989. 2613444–3453.
29. Rodriguez-Roisin R. Pulmonary gas exchange in acute respiratory failure. Eur J Anaesthesiol 1994. 115–13.

Article information Continued

Table 1

Causes of Airflow Limitation in COPD

Table 1