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Respir Med. 2015 Jul;109(7):785-802. doi: 10.1016/j.rmed.2015.03.010. Epub 2015 Apr 3.

Mechanisms, assessment and therapeutic implications of lung hyperinflation in COPD.

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Pulmonary Unit, General Hospital, University of Verona, Italy; Associazione Italiana Pneumologi Ospedalieri (AIPO), Italy.
Clinical Physiology Department, Pulmonology Research Institute, Moscow, Russia; Russian Respiratory Society (RRS), Russia.
Russian Respiratory Society (RRS), Russia; Clinical Department, Pulmonology Research Institute, Moscow, Russia.
Department of Clinical and Molecular Bio-Medicine, University of Catania, Italy; Società Italiana di Medicina Respiratoria (SIMeR), Italy.
Mondo Medico, Multidisciplinary and Rehabilitation Outpatient Clinic, Borgomanero (No), Italy; Associazione Scientifica Interdisciplinare per lo Studio delle Malattie Respiratorie (AIMAR), Italy.
Pneumology Department, Hospital Universitario de Guadalajara, Universidad de Alcalá de Henares, Spain; Spanish Society of Pneumology and Thoracic Surgery (SEPAR), Spain.
Respiratory and Intensive Care Medicine, Cochin Hospital Group, Val-de-Grâce Hospital, University Paris Descartes (EA2511), Paris, France.
Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologieet Réanimation Médicale (Département "R3S"), F-75013 Paris, France; INSERM and UPMC, Univ Paris 06, UMR_S 1158, "Neurophysiologie Respiratoire Expérimentaleet Clinique", Paris, France.
Pulmonary Research Institute at Lung Clinic Grosshansdorf, Airway Research Center North, German Center for Lung Research, Grosshansdorf, Deutsche Gesellschaft fuer Pneumologie und Beatmungsmedizin, Germany.
Departments of Pneumology and Cardiology, Hospital Fürth, University Erlangen-Nürnberg, Fürth, Deutsche Gesellschaft fuer Pneumologie und Beatmungsmedizin, Deutsche Atemwegsliga, Germany.
Spanish Society of Pneumology and Thoracic Surgery (SEPAR), Spain; Pneumology Department, Hospital Universitari Vall d'Hebron, CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain. Electronic address:


The main complaint of patients with chronic obstructive pulmonary disease (COPD) is shortness of breath with exercise, that is usually progressive. The principal mechanism that explains this symptom is the development of lung hyperinflation (LH) which is defined by an increase of functional residual capacity (FRC) above predicted values. Patients with COPD may develop static LH (sLH) because of destruction of pulmonary parenchyma and loss of elastic recoil. In addition, dynamic LH (dLH) develops when patients with COPD breathe in before achieving a full exhalation and, as a consequence, air is trapped within the lungs with each further breath. Dynamic LH may also occur at rest but it becomes clinically relevant during exercise and exacerbation. Lung hyperinflation may have an impact beyond the lungs and the effects of LH on cardiovascular function have been extensively analysed. The importance of LH makes its identification and measurement crucial. The demonstration of LH in COPD leads to the adoption of strategies to minimise its impact on the daily activities of patients. Several strategies reduce the impact of LH; the use of long-acting bronchodilators has been shown to reduce LH and improve exercise capacity. Non pharmacologic interventions have also been demonstrated to be useful. This article describes the pathophysiology of LH, its impact on the lungs and beyond and reviews the strategies that improve LH in COPD.


COPD; Diagnosis; Lung hyperinflation; Pathogenesis; Treatment

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