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Review
. 2024 Jul 2:19:1561-1578.
doi: 10.2147/COPD.S458324. eCollection 2024.

Lung Hyperinflation as Treatable Trait in Chronic Obstructive Pulmonary Disease: A Narrative Review

Maud Koopman  1   2   3 , Rein Posthuma  1   2   3 , Lowie E G W Vanfleteren  4 , Sami O Simons  2   3 , Frits M E Franssen  1   2   3
Affiliations
Review

Lung Hyperinflation as Treatable Trait in Chronic Obstructive Pulmonary Disease: A Narrative Review

Maud Koopman et al. Int J Chron Obstruct Pulmon Dis. .

Abstract

Lung hyperinflation (LH) is a common clinical feature in patients with chronic obstructive pulmonary disease (COPD). It results from a combination of reduced elastic lung recoil as a consequence of irreversible destruction of lung parenchyma and expiratory airflow limitation. LH is an important determinant of morbidity and mortality in COPD, partially independent of the degree of airflow limitation. Therefore, reducing LH has become a major target in the treatment of COPD over the last decades. Advances were made in the diagnostics of LH and several effective interventions became available. Moreover, there is increasing evidence suggesting that LH is not only an isolated feature in COPD but rather part of a distinct clinical phenotype that may require a more integrated management. This narrative review focuses on the pathophysiology and adverse consequences of LH, the assessment of LH with lung function measurements and imaging techniques and highlights LH as a treatable trait in COPD. Finally, several suggestions regarding future studies in this field are made.

Keywords: COPD; emphysema; hyperinflation; phenotype; treatable trait.

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Conflict of interest statement

Dr Lowie Vanfleteren reports grants and/or personal fees from AstraZeneca, GSK, Novartis, Boehringer, Pulmonx and Chiesi outside the submitted work. Dr Sami Simons reports grants and personal fees from AstraZeneca, Chiesi, Boehringer Ingelheim, GlaxoSmithKline and Roche outside the submitted work. Prof. Dr. Frits Franssen reports personal fees from AstraZeneca, Chiesi, GlaxoSmithKline, MSD and Verona Pharma outside the submitted work. The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
Change in end-expiratory lung volume (EELV) with COPD. EELV is set at the point at which the elastic recoil pressures of the lung and chest wall are equal and opposite in direction. In COPD patients with hyperinflation, emphysema decreases lung elastic recoil pressure and causes a reset of functional residual capacity, or EELV, at a higher absolute lung volume. The difference between expected (long-dashed horizontal lines) and observed EELV (short-dashed horizontal lines) represent static hyperinflation. Reprinted from Dubé B, Guerder, (A), Morelot-Panzini, (C) et al. The clinical relevance of the emphysema-hyperinflated phenotype in COPD. COPD Research and Practice. 2015;2(1). This source is Open Access, the figure was copied under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/).
Figure 2
Figure 2
Heterogeneity of lung function impairment in patients with COPD.
Figure 3
Figure 3
Clinical and radiologic presentation of lung hyperinflation.
See this image and copyright information in PMC

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MeSH terms