Biomedical Engineering Reference
In-Depth Information
18
Mechanisms of Pulmonary
Vascular Changes
Joan A. Barber
`
, Victor I. Peinado, and Robert Rodriguez-Roisin
Servei de Pneumologia, Hospital Clinic, Institut d'Investigacions
Biomediques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona,
Barcelona, Spain
I.
INTRODUCTION
Pulmonary circulation abnormalities are common in COPD (1). Presum-
ably, pulmonary hypertension associated with COPD is the most frequent
form of presentation of this disorder. The field of vascular biology has
experienced a tremendous evolution in the last decades, since the seminal
studies by Furchgott and Zawadzki (2) identified the key role of endo-
thelium in the regulation of vascular homeostasis. Concepts gathered in
the systemic circulation have contributed to better understand changes
occurring in pulmonary vessels. This has promoted a switch in the notion
of the pathogenesis of pulmonary hypertension from a vasoconstrictive
phenomenon to a cell proliferative disorder. This conception has facilitated
the development of new therapeutic strategies for some of the most severe
forms of pulmonary hypertension (3).
Some of the concepts used to explain the pathogenesis of the most
severe forms of pulmonary hypertension have been applied to COPD, yield-
ing to new proposals for its pathobiology. In the present chapter, we will
review the current knowledge on the mechanisms of pulmonary vascular
changes associated with COPD.
463
