O'Donnell Denis E, Laveneziana Pierantonio
Division of Respiratory and Critical Care Medicine, Departments of Medicine and Physiology, Queen's University, Kingston, Ontario, Canada.
COPD. 2006 Dec;3(4):219-32. doi: 10.1080/15412550600977478.
Lung hyperinflation commonly accompanies expiratory flow-limitation in patients with Chronic Obstructive Pulmonary Disease (COPD) and contributes importantly to dyspnea and activity limitation. It is not surprising, therefore, that lung hyperinflation has become an important therapeutic target in symptomatic COPD patients. There is increasing evidence that acute dynamic increases in lung hyperinflation, under conditions of worsening expiratory flow-limitation and increased ventilatory demand (or both) can seriously stress cardiopulmonary reserves, particularly in patients with more advanced disease. Our understanding of the physiological mechanisms of dynamic lung hyperinflation during both physical activity and exacerbations in COPD continues to grow, together with an appreciation of its serious negative mechanical and sensory consequences. In this review, we will discuss the basic pathophysiology of COPD during rest, exercise and exacerbation so as to better understand how this can be pharmacologically manipulated for the patient's benefit. Finally, we will review current concepts of the mechanisms of symptom relief and improved exercise endurance following pharmacological lung volume reduction.
肺过度充气在慢性阻塞性肺疾病（COPD）患者中通常伴随着呼气气流受限，并在呼吸困难和活动受限方面起着重要作用。因此，肺过度充气已成为有症状的COPD患者的重要治疗靶点也就不足为奇了。越来越多的证据表明，在呼气气流受限恶化和通气需求增加（或两者兼有）的情况下，肺过度充气的急性动态增加会严重影响心肺储备，尤其是在病情更严重的患者中。我们对COPD患者在体力活动和病情加重期间动态肺过度充气的生理机制的理解不断加深，同时也认识到其严重的负面机械和感觉后果。在这篇综述中，我们将讨论COPD在静息、运动和病情加重期间的基本病理生理学，以便更好地理解如何通过药物治疗来改善患者的状况。最后，我们将回顾药物性肺容积减少后症状缓解和运动耐力改善机制的当前概念。
