COPD exacerbations · 3: Pathophysiology

O'Donnell, D. E.; Parker, C. M.
April 2006
Thorax;Apr2006, Vol. 61 Issue 4, p354
Academic Journal
Exacerbations of chronic obstructive pulmonary disease (COPD) are associated with increased morbidity and mortality. The effective management of COPD exacerbations awaits a better understanding of the underlying pathophysiological mechanisms that shape its clinical expression. The clinical presentation of exacerbations of COPD is highly variable and ranges from episodic symptomatic deterioration that is poorly responsive to usual treatment, to devastating life threatening events. This underscores the heterogeneous physiological mechanisms of this complex disease, as well as the variation in response to the provoking stimulus. The derangements in ventilatory mechanics, muscle function, and gas exchange that characterise severe COPD exacerbations with respiratory failure are now well understood. Critical expiratory flow limitation and the consequent dynamic lung hyperinflation appear to be the proximate deleterious events. Similar basic mechanisms probably explain the clinical manifestations of less severe exacerbations of COPD, but this needs further scientific validation. In this review we summarise what we have learned about the natural history of COPD exacerbations from clinical studies that have incorporated physiological measurements. We discuss the pathophysiology of clinically stable COPD and examine the impact of acutely increased expiratory flow limitation on the compromised respiratory system. Finally, we review the chain of physiological events that leads to acute ventilatory insufficiency in severe exacerbations.


Related Articles

  • Nocturnal non-invasive ventilation in addition to rehabilitation in hypercapnic patients with COPD. Duiverman, M. L.; Wempe, J. B.; Bladder, G.; Jansen, D. F.; Kerstjens, H. A. M.; Zijlstra, J. G.; Wijkstra, P. J. // Thorax;Dec2008, Vol. 63 Issue 12, p1052 

    Background: Long-term non-invasive positive pressure ventilation (NIPPV) might improve the outcomes of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease (COPD) with chronic respiratory failure. A study was undertaken to investigate whether nocturnal NIPPV in...

  • Correlation Between the %MinVol Setting and Work of Breathing During Adaptive Support Ventilation in Patients with Respiratory Failure. Chin-Pyng Wu; Hen-I Lin; Wann-Chern Perng; Shih-Hsing Yang; Chien-Wen Chen; Huang, Yuh-Chin T.; Kun-Lun Huang // Respiratory Care;Mar2010, Vol. 55 Issue 3, p334 

    BACKGROUND: Adaptive support ventilation (ASV) is a new mode of mechanical ventilation that seeks an optimal breathing pattern based on the minimum work of breathing (WOB) principle. The operator's manual for the ventilators that provide ASV recommends that the %MinVol setting be started at 100%...

  • Pulmonary gas exchange response to weaning with pressure-support ventilation in exacerbated chronic obstructive pulmonary disease patients. Ferrer, Miquel; Iglesia, Raquel; Roca, Josep; Burgos, Felip; Torres, Antoni; Rodriguez-Roisin, Robert // Intensive Care Medicine;Nov2002, Vol. 28 Issue 11, p1595 

    Objective. To assess if pressure-support ventilation (PSV) can improve ventilation-perfusion (VA/Q) imbalance observed during the transition from positive-pressure ventilation to spontaneous breathing in intubated chronic obstructive pulmonary disease (COPD) patients during weaning. Design....

  • Holmium:YAG laser bronchoscopy ablation of benign and malignant airway obstructions: an 8-year experience. Squiers, John; Teeter, William; Hoopman, John; Piepenbrok, Kristy; Wagner, Richard; Ferguson, Robert; Nagji, Alykhan; Peltz, Matthias; Wait, Michael; DiMaio, J. // Lasers in Medical Science;Jul2014, Vol. 29 Issue 4, p1437 

    Patients suffering from severe tracheobronchial obstruction are vulnerable to dyspnea, respiratory failure, obstructive pneumonia, and death. Treatment with a holmium:YAG laser, an alternative to the neodymium:YAG laser, may provide symptomatic relief. This is the largest case series to date...

  • COMMENTARY: Noninvasive positive-pressure ventilation increased risk for death in respiratory failure after extubation. Sinuff, Tasnim // ACP Journal Club;Nov/Dec2004, Vol. 141 Issue 3, p71 

    The article presents a commentary on the study, which concluded that noninvasive positive-pressure ventilation (NIPPV) increased risk for death in respiratory failure after extubation. The addition of NIPPV to standard medical therapy for acute respiratory failure (ARE) may reduce endotracheal...

  • Effects of Different Mechanical Ventilation Parameters on Intra-Abdominal Pressure in COPD Patients. ZHAO Yong; ZHAO Xiaoyun; LI Yuechuan // Tianjin Medical Journal;2014, Vol. 42 Issue 7, p690 

    Objective To discuss the effect of different mechanical ventilation parameters on intra-abdominal pressure. Methods A total of 42 cases with mechanical ventilation suffering from chronic obstructive pulmonary diseases (COPD) and respiratory failure were selected for observing the effects of...

  • BREATHING SPACE. Heslop, Karen // Nursing Standard;8/2/2006, Vol. 20 Issue 47, p24 

    Plans for a national service framework for chronic obstructive pulmonary disease (COPD) were announced recently. Care tailored to individual needs pays dividends.

  • Respiratory mechanics and ventilatory control in overlap syndrome and obesity hypoventilation. Verbraecken, Johan; McNicholas, Walter T. // Respiratory Research;Nov2013, Vol. 14 Issue 11, p1 

    The overlap syndrome of obstructive sleep apnoea (OSA) and chronic obstructive pulmonary disease (COPD), in addition to obesity hypoventilation syndrome, represents growing health concerns, owing to the worldwide COPD and obesity epidemics and related co-morbidities. These disorders constitute...

  • Understanding wasted/ineffective efforts in mechanically ventilated COPD patients using the Campbell diagram. Vassilakopoulos, Theodoros // Intensive Care Medicine;Jul2008, Vol. 34 Issue 7, p1336 

    The article focuses on the study of wasted of ineffective efforts in mechanically ventilated chronic obstructive pulmonary disease (COPD) patients using the Campbell diagram. It explores the process of constructing the Campbell diagram. Several questions considered in the study are discussed,...


Read the Article


Sign out of this library

Other Topics