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J Appl Physiol 107: 309-314, 2009. First published April 9, 2009; doi:10.1152/japplphysiol.00008.2009
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REVIEW

HIGHLIGHTED TOPIC
The Respiratory Muscles in Chronic Obstructive Pulmonary Disease

Pulmonary characteristics in COPD and mechanisms of increased work of breathing

Stephen H. Loring,1,2 Mauricio Garcia-Jacques,1 and Atul Malhotra3,1

1Department of Anesthesia and Critical Care, Beth Israel Deaconess Medical Center, Boston; 2Harvard Medical School, Boston; and 3Division of Pulmonary and Critical Care and the Division of Sleep Medicine, Brigham and Women's Hospital, Boston, Massachusetts

Submitted 7 January 2009 ; accepted in final form 8 April 2009

ABSTRACT

Mechanical characteristics and gas exchange inefficiencies of the lungs contribute to increased work of ventilation in chronic obstructive pulmonary disease (COPD) at rest and exercise, and the energy cost of ventilation is increased in COPD at any external work level. Assuming typical ventilatory variables and respiratory characteristics, we estimated the relative contributions of inspiratory and expiratory resistance, dynamic elastance, intrinsic positive end-expiratory pressure, and gas exchange inefficiency to the work of breathing, finding that the last of these is likely to be of major importance. Dynamic hyperinflation can be seen as both an impediment to inspiratory muscle function and an essential component of adaptation to severe obstruction. Extrinsic restriction, in which the chest wall fails to achieve and maintain abnormally high lung volumes in COPD, can limit ventilatory function and contribute to disability.

respiratory mechanics; Campbell diagram; extrinsic restriction; pleural pressure; ventilation


Address for reprint requests and other correspondence: S. H. Loring, Beth Israel Deaconess Medical Center, 330 Brookline Ave., DA 717, Boston, MA 02215 (e-mail: sloring{at}bidmc.harvard.edu)




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