J Korean Med Assoc.  2006 Apr;49(4):305-312. 10.5124/jkma.2006.49.4.305.

Pathophysiology of Chronic Obstructive Pulmonary Disease

• Lee SD

• KMID: 1958284
• DOI: http://doi.org/10.5124/jkma.2006.49.4.305

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.

Keyword

Chronic obstructive pulmonary disease; Chronic obstructive bronchitis; Emphysema; Airflow limitation; Pathophysiology

MeSH Terms

Emphysema
Gases
Hypertension, Pulmonary
Lung
Mucus
Oxidative Stress
Peptide Hydrolases
Pneumonia
Pulmonary Disease, Chronic Obstructive*
Pulmonary Heart Disease
Gases
Peptide Hydrolases

Reference

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. 163:1256–1276.

2. Mullen JB, Wright JL, Wiggs BR, Pare PD, Hogg JC. Reassessment of inflammation of airways in chronic bronchitis. BMJ (Clin Res Ed). 1985. 291:1235–1239.

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. 298:1277–1281.

4. Matsuba K, Thurlbeck WM. The number and dimensions of small airways in emphysematous lungs. Am J Pathol. 1972. 67:265–275.

5. Hogg JC, Macklem PT, Thurlbeck WM. Site and nature of airway obstruction in chronic obstructive lung disease. N Engl J Med. 1968. 278:1355–1360.

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. 148:1220–1225.

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. 2:834–839.

8. Dayman H. Mechanics of airflow in health and emphysema. J Clin Invest. 1951. 30:1175–1190.

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. 39:584–591.

10. Mead J, Turner JM, Macklem PT, Little JB. Significance of the relationship between lung recoil and maximum expiratory flow. J Appl Physiol. 1967. 22:95–108.

11. Burnett D, Stockley RA. Serum and sputum alpha 2 macroglobulin in patients with chronic obstructive airways disease. Thorax. 1981. 36:512–516.

12. Lane DJ, Howell JB, Giblin B. Relation between airways obstruction and CO2 tension in chronic obstructive airways disease. BMJ. 1968. 3:707–709.

13. Rodriguez-Roisin R, MacNee W. Pathophysiology of chronic obstructive pulmonary disease. Postma DS, Siafakas MN, editors. Pathophysiology of chronic Management of chronic obstructive pulmonary disease. European Respiratory Monograph. 1998. 3:107–106.

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. 47:144–149.

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. 149:423–429.

16. MacNee W. Pathophysiology of cor pulmonale in chronic obstructive pulmonary disease. Part two. Am J Respir Crit Care Med. 1994. 150:1158–1168.

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. 221:1283–1285.

18. Biernacki W, Flenley DC, Muir AL, MacNee W. Pulmonary hypertension and right ventricular function in patients with COPD. Chest. 1988. 94:1169–1175.

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. 150:1646–1652.

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. 26:766–774.

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. 52:929–931. 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. 158:1511–1517.

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. 152:1926–1931.

24. Turner MO, Hussack P, Sears MR, Dolovich J, Hargreave FE. Exacerbations of asthma without sputum eosinophilia. Thorax. 1995. 50:1057–1061.

25. Fahy JV, Kim KW, Liu J, Boushey HA. Prominent neutrophilic inflammation in sputum from subjects with asthma exacerbation. J Allergy Clin Immunol. 1995. 95:843–852.

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. 10:1285–1291.

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. 161:1608–1613.

28. Schmidt GA, Hall JB. Acute or chronic respiratory failure. Assessment and management of patients with COPD in the emergency setting. JAMA. 1989. 261:3444–3453.

29. Rodriguez-Roisin R. Pulmonary gas exchange in acute respiratory failure. Eur J Anaesthesiol. 1994. 11:5–13.