Changes in ventilation-perfusion during and after an COPD exacerbation: an assessment using fluid dynamic modeling

Int J Chron Obstruct Pulmon Dis. 2018 Mar 6;13:833-842. doi: 10.2147/COPD.S153295. eCollection 2018.


Introduction: Severe exacerbations associated with chronic obstructive pulmonary disease (COPD) that require hospitalization significantly contribute to morbidity and mortality. Definitions for exacerbations are very broad, and it is unclear whether there is one predominant underlying mechanism that leads to them. Functional respiratory imaging (FRI) with modeling provides detailed information about airway resistance, hyperinflation, and ventilation-perfusion (V/Q) mismatch during and following an acute exacerbation.

Materials and methods: Forty-two patients with COPD participating in a multicenter study were assessed by FRI, pulmonary function tests, and self-reported outcome measures during an acute exacerbation and following resolution. Arterial blood gasses and lung function parameters were measured.

Results: A significant correlation was found between alveolar-arterial gradient and image-based V/Q (iV/Q), suggesting that iV/Q represents V/Q mismatch during an exacerbation (p<0.05).

Conclusion: Recovery of an exacerbation is due to decreased (mainly distal) airway resistance (p<0.05). Improvement in patient-reported outcomes were also associated with decreased distal airway resistance (p<0.05), but not with forced expiratory volume. FRI is, therefore, a sensitive tool to describe changes in airway caliber, ventilation, and perfusion during and after exacerbation. On the basis of the fact that FRI increased distal airway resistance seems to be the main cause of an exacerbation, therapy should mainly focus on decreasing it during and after the acute event.

Keywords: acute exacerbation; airway resistance; functional respiratory imaging; high-resolution computed tomography; ventilation–perfusion.

Publication types

  • Clinical Trial
  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Airway Resistance*
  • Blood Gas Analysis
  • Disease Progression
  • Europe
  • Female
  • Forced Expiratory Volume
  • Humans
  • Lung / blood supply*
  • Lung / diagnostic imaging*
  • Lung / physiopathology
  • Male
  • Middle Aged
  • Patient-Specific Modeling*
  • Perfusion Imaging / methods*
  • Predictive Value of Tests
  • Prognosis
  • Pulmonary Circulation
  • Pulmonary Disease, Chronic Obstructive / diagnostic imaging*
  • Pulmonary Disease, Chronic Obstructive / physiopathology
  • Recovery of Function
  • Self Report
  • Tomography, X-Ray Computed*
  • Ventilation-Perfusion Ratio*
  • Vital Capacity