Chronic obstructive bronchopulmonary disease: II. Oxygen transport in two clinical types

doi:10.1016/0002-9343(68)90234-9

The American Journal of Medicine

Volume 44, Issue 1, January 1968, Pages 26-38

https://doi.org/10.1016/0002-9343(68)90234-9 Get rights and content

Abstract

Two contrasting types of patients with chronic airway obstruction were distinguished by purely clinical criteria: the emphysematous type (herein referred to as PP patients) and the bronchial type (BB patients). In the autopsy cases there was somewhat more extensive emphysematous destruction of the lungs and much less evidence of active bronchial mucous gland hyperplasia in the former type than in the latter. These two types of patients were studied physiologically and were found to have equivalent degrees of ventilatory impairment. However, PP patients had larger lungs, more uniform distribution of inert gas (helium) and hyperventilated both at rest and during exercise. BB patients had higher carbon dioxide tensions and much lower arterial oxygen saturations than did PP patients. The severe hypoxemia in BB patients was not caused by alveolar hypoventilation per se nor could it be satisfactorily explained by calculations of gas and blood flow distribution in the lungs.

The most consistent measured difference relevant to pulmonary oxygen transport in the two types was in pulmonary blood flow: PP patients had subnormal and BB patients normal cardiac outputs both at rest and during exercise. The higher ratio of total ventilation to total blood flow in PP patients probably accounted for the nearly normal arterial oxygenation. The hypoxemia in BB patients is considered to be a form of diffusion impairment resulting from too rapid flow of red blood cells through hypoventilated alveoli.

The most consistent measured difference relevant to tissue oxygenation in the two types was in the systemic oxygen transport (product of total blood flow and arterial blood oxygen content). Because of their low cardiac outputs, PP patients, although their arterial blood had a higher oxygen pressure, delivered less oxygen to their tissues than BB patients, who maintained a normal cardiac output despite a greater degree of pulmonary hypertension. These findings may account for the cachexia of the former and the cor pulmonale of the latter patients.

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^☆: A preliminary report was presented at the 9th Annual Emphysema Conference, June 1966. This study was supported by U. S. Public Health Service Research Grants HE-93191 and HE06067-05, Department of the Army, Research and Development Branch Contract 193-MD-2227 and Vocational Rehabilitation Administration Grant RT-10.

¹: From The Webb-Waring Institute for Medical Research and the Department of Medicine, University of Colorado Medical Center, Denver, Colorado.

^†: Fellow, U. S. Public Health Training Grant HE-5450. Present address: General Rose Hospital, Denver, Colorado.

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Clinical studyChronic obstructive bronchopulmonary disease: II. Oxygen transport in two clinical types☆

Abstract

Lancet

J. Biol. Chem.

Respiratory insufficiency

Lancet

Pulmonary emphysema. Etiologic factors and clinical forms

Ann. Int. Med.

Chronic obstructive bronchopulmonary disease. I. Clinical features

Am. Rev. Resp. Dis.

The slow space in chronic obstructive pulmonary disease

Ann. New York Acad. Sc.

The diagnosis of pulmonary emphysema in the presence of chronic bronchitis

Quart. J. Med.

The fighter versus the non-fighter

Arch. Environ. Health

Studies on the intrapulmonary mixture of gases. III. An open circuit method for measuring residual air

J. Clin. Invest.

The volume of the lung determined by helium dilution. Description of the method and comparison with other procedures

J. Clin. Invest.

Volume displacement body plethysmograph for respiratory measurements in human subjects

J. Appl. Physiol.

Intrapulmonary mixing of helium in health and in emphysema

Clin. Sc.

Respiratory Function in Disease

Further studies on the intrapulmonary mixing of helium in normal and emphysematous subjects

Clin. Sc.

Carbon monoxide uptake and pulmonary diffusing capacity in normal subjects at rest and during exercise

J. Clin. Invest.

The pulmonary diffusing capacity in normal subjects

J. Physiol.

The significance of morphologic chronic hyperplastic bronchitis

Am. Rev. Resp. Dis.

Clinico-physiologic evaluation of physical working capacity in persons with pulmonary disease

Am. Rev. Resp. Dis.

The relationship between clinical and physiological findings in chronic obstructive disease of the lungs

Med. Thoracalis

Clinical study
Chronic obstructive bronchopulmonary disease: II. Oxygen transport in two clinical types☆