Chronic obstructive pulmonary disease: clinical integrative physiology

Clin Chest Med. 2014 Mar;35(1):51-69. doi: 10.1016/j.ccm.2013.09.008. Epub 2013 Dec 12.


Peripheral airway dysfunction, inhomogeneous ventilation distribution, gas trapping, and impaired pulmonary gas exchange are variably present in all stages of chronic obstructive pulmonary disease (COPD). This article provides a cogent physiologic explanation for the relentless progression of activity-related dyspnea and exercise intolerance that all too commonly characterizes COPD. The spectrum of physiologic derangements that exist in smokers with mild airway obstruction and a history compatible with COPD is examined. Also explored are the perceptual and physiologic consequences of progressive erosion of the resting inspiratory capacity. Finally, emerging information on the role of cardiocirculatory impairment in contributing to exercise intolerance in patients with varying degrees of airway obstruction is reviewed.

Keywords: Cardiac output; Chronic obstructive pulmonary disease; Dyspnea; Exercise; Lung mechanics; Small airways.

Publication types

  • Review

MeSH terms

  • Dyspnea / physiopathology
  • Exercise / physiology*
  • Exercise Tolerance / physiology
  • Humans
  • Lung / physiopathology*
  • Pulmonary Disease, Chronic Obstructive / physiopathology*
  • Pulmonary Gas Exchange
  • Respiratory Mechanics / physiology*