Pathophysiology

The destruction of the architectural framework of the lung causes distinct functional impairments:

  • Loss of Elastic Recoil: Elastin degradation reduces the lung's natural passive recoil. The lungs expand easily (increased compliance) but struggle to expel air.

  • Airway Collapse and Air Trapping: Healthy alveoli act like guy-wires, providing radial traction that holds the small, non-cartilaginous airways open during expiration. Without this tethering force, the small airways collapse early during exhalation. This traps air distally, resulting in progressive hyperinflation and an increased residual volume (RV).

  • Impaired Gas Exchange: The destruction of alveolar septa dramatically reduces the total surface area available for gas diffusion. Concurrently, the adjacent pulmonary capillary bed is obliterated. This creates a ventilation-perfusion ($V/Q$) mismatch and reduces the diffusing capacity of the lung for carbon monoxide ($DL_{CO}$), eventually leading to hypoxemia and hypercapnia.

 

 

 

 

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