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COPD Research and Practice

, 2:1

First Online: 13 January 2016Received: 15 November 2015Accepted: 29 December 2015


The classification of chronic pulmonary obstructive disease COPD into clinical and pathophysiological subsets is not new, but increasing data is available on the relation of these different phenotypes to clinically meaningful outcomes. This review focuses on the -emphysema-hyperinflation- EH phenotype, which is characterised by a prominent loss of lung elastic recoil and hyperinflation burden that translates into marked exercise intolerance and a heightened sense of dyspnoea.

Although no single genetic profile has been associated with the EH phenotype, recent data have shown that certain single nucleotide polymorphisms, such as DNAH5, appear to have an effect on the preferential development of hyperinflation in smokers. Static and dynamic hyperinflation are hallmarks of the EH phenotype, and abnormal increases in resting lung function indices such as total lung capacity TLC, functional residual capacity FRC and inspiratory to TLC ratio IC-TLC seem more associated with the clinical EH phenotype than others markers of gas trapping.

An increased level of dyspnoea on exertion and exercise intolerance are also characteristic of the EH presentation and are likely related in part to critical mechanical constraints imposed on tidal volume expansion in situations where ventilatory demands are increased, but also possibly on cardiac and hemodynamic anomalies related to emphysema and hyperinflation. Importantly, the clinical relevance of the EH phenotype is underlined by the finding that indices of hyperinflation such as IC-TLC and residual volume RV can be used as independent predictors of mortality in patients with COPD.

Treatment of patients with the EH phenotype should primarily focus on smoking cessation and maximal bronchodilator therapy. New long-acting combined bronchodilators options provide clinicians with safe and effective ways to address the hyperinflation issue in this population. Pulmonary rehabilitation also has a positive impact on exercise tolerance, quality of life and hyperinflation, and should be routinely considered in patients with EH presentation that remain symptomatic despite optimal treatment, whereas as lung volume reduction techniques should be reserved for highly selected patients.

KeywordsStatic hyperinflation Dynamic hyperinflation Phenotype Dyspnoea COPD Emphysema AbbreviationsADLActivities of daily living

BLVRBronchoscopic lung volume reduction

BMIBody mass index

BODE indexBody mass index, airflow Obstruction, Dyspnoea and Exercise capacity index

COPDChronic obstructive lung disease

CTComputed tomography

DHDynamic hyperinflation

DLCODiffusion capacity of the lung for carbon monoxide

DNAH5Dynein, axonemal, heavy chain 5

ECLIPSEEvaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints

EELVEnd-expiratory lung volume

EHEmphysema-hyperinflated phenotype

EPHX1Microsomal epoxide hydrolase

FEV1Forced expiratory volume in 1 s

FRCFunctional residual capacity

FVCForced vital capacity

GOLDGlobal initiative for Obstructive Lung Disease

GSTP1Glutathione S-transferase P1

ICInspiratory capacity

ICSInhaled corticosteroids

IRVInspiratory reserve volume

LVRSLung volume reduction surgery

NETTNational Emphysema Treatment Trial

PRPulmonary rehabilitation

RVResidual volume

SNPSingle nucleotide polymorphism

TLCTotal lung capacity

ULNUpper limit of normality

VO2Oxygen uptake

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Autor: Bruno-Pierre Dubé - Antoine Guerder - Capucine Morelot-Panzini - Pierantonio Laveneziana


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