Posted on Leave a comment

The Epidemiology of Vascular Dysfunction Relating to Chronic Obstructive Pulmonary Disease and Emphysema

copd

Cor pulmonale has long been described in very severe chronic obstructive pulmonary disease (COPD) and emphysema. Cross-sectional results from population-based studies show that left ventricular filling and a variety of vascular measures in the systemic circulation are abnormal in preclinical COPD and emphysema and that a predominant vascular change in COPD and emphysema is endothelial and microvascular dysfunction. 

Share it:

Share on facebook
Share on google
Share on twitter
Share on linkedin
Share on whatsapp
Share on email

These findings suggest that pulmonary vascular changes may occur early in COPD and emphysema and might contribute to pathogenesis. However, longitudinal epidemiologic studies with direct measures of the pulmonary vasculature are lacking; therefore, inferences are limited at present. New imaging-based approaches to the assessment of the pulmonary vasculature are applicable to epidemiologic studies and may help in defining the relationship of pulmonary vascular damage to progression of COPD and emphysema. These measures may also provide imaging-based surrogate markers, and novel therapeutics targeted to the pulmonary vasculature might reduce symptoms and improve function in these common diseases.

Cor Pulmonale: Pulmonary Heart Disease

Increased pulmonary vascular resistance and right heart failure have long been known to occur in very severe chronic obstructive pulmonary disease (COPD) and emphysema (1). Classic reports of cor pulmonale describe elevated pulmonary vascular resistance and right heart failure with reductions in left ventricular filling, left ventricular stroke volume, and cardiac output, but generally preserved left ventricular ejection fraction (24).

Clinical experience has demonstrated mild resting pulmonary hypertension in severe COPD without a significant reduction in left ventricular ejection fraction, although exercise-induced pulmonary hypertension is more common (1). In this usual schema, cor pulmonale is generally absent in mild, moderate, and even severe COPD but develops as an effect of end-stage, very severe COPD. The relationship between the FEV1 and left ventricular stroke volume can be conceptualized as resembling a hockey stick, with little effect of airflow limitation on left ventricular hemodynamics until the FEV1 is very severely reduced.

Conclusions

Cor pulmonale has long been described in very severe COPD and emphysema. Cross-sectional results from population-based studies that have used a variety of vascular measures in the systemic circulation suggest that the predominant vascular change in COPD and particularly emphysema is endothelial and microvascular dysfunction. Longitudinal epidemiologic studies with direct measures of the pulmonary vasculature are lacking to date; therefore, inferences on cause and effect are limited at present. New imaging-based approaches to the assessment of the pulmonary vasculature are applicable to epidemiologic studies and may soon help in defining the relationship of pulmonary vascular damage to progression of emphysema and COPD and may provide imaging-based surrogate markers. Extant cardiovascular drugs and novel therapeutic agents targeted to the pulmonary vasculature might reduce symptoms and improve function in emphysema and COPD. Statins, for example, have long been known to improve endothelial function in humans and have recently been shown to improve pulmonary arterial endothelial function, reduce pulmonary artery pressure, and reduce emphysema in animals exposed to cigarette smoke (66).

HOW D’OXYVA CAN HELP?

D’OXYVA is the only fully noninvasive, completely painless (over-the-skin) microcirculatory solution that has been validated to significantly improve microcirculation.

D’OXYVA’s versatile, over-the-skin, non-toxic CO₂ and soothing vapor delivery system has the potential to dramatically improve microcirculation and the comprehensive function of developing lungs.

Was the article informative?