Could someone give a easy to understand explanation of ventilation/perfusion mismatch and how it relates to COPD? I am studying pulmonology and am beginning to have a good understanding of cor pulmonale and pulmonary hypertension. I have gotten some good sources from Google but thought I would post here to get even more.
My specific questions are:
How does ventilation/perfusion mismatch relate to COPD?
COPD is characterized by chronic inflammation in the airways, parynchema and pulmonary vasculature. This is not the only mechanism involved in the pathogenisis of COPD, but it is the primary process. The label COPD includes two types of obstructive airway diseases. Chronic Bronchitis (in which other causes of chronic coughing have been ruled out) and Emphysema (structural remodeling and enlargement of air-spaces distal to the terminal bronchioles w/o obvious fibrosis). Most people suffering from COPD have a mixture of the two diseases. Air is able to move in, but not out.
Chronic bronchitis starts with an insult to the lungs in the form of an inhaled irritant. Inlammatory cells (macrophages, lymphocytes and later neutrophils) respond and release inflammatory mediators (leukotrienes, interleukins, and tumor necrosis factor) which damage the tissues of the lungs.
Now go to your knowledge of the inflammatory response: Excess mucous production, constriction of airways. These repeated cycles and repeated insults result in collagen deposits / scar tissue formation / fibrosis.
Tissue destruction of the parynchema is theorized to be a consequence of inflammation (but there are also genetic causes such as a deficiency in alpha 1-antitrypsin) and includes a loss of attachments (which hold airways open and leads to the collapse of peripheral airways) and destruction of alveolar capillary beds. Inflammatory cells also infiltrate the smooth muscle of pulmonary vasculature causing them to thicken as the disease progresses.
With the concurrent loss of the integrity alevolar walls and their surrounding cappillaries, the surface area available to diffuse O2 is decreased... Ventilation is still availble; however perfusion is diminished :. ventilation / perfusion mismatch (also known as v/q mismatch)
Hope that helps! Sorry I don't have an answer to your pulmonary artery vasoconstriction: My best guess is that since COPD'ers are hypoxemic the body is trying to increase perfusion to the lungs.
***referenced
Medical Surgical Nursing: Assessment and Management of Clinical Problems 7th edition (Lewis, Heitkemper, Dirksen, O'brien, and Bucher)