Pulmonary fibrosis (PF) is a condition that often refers to a group of interstitial lung diseases which are characterized by a buildup of fibrotic scar tissue on the lungs. This scarring is often a natural response to injury, toxins or chronic irritation from environmental exposure or infection. Some patients experience fibrosis of the lung without any identifiable cause, which is referred to as idiopathic pulmonary fibrosis (IPF). If you or a loved one has been diagnosed with IPF, you may be wondering about V/Q mismatch, what causes it and how it relates to pulmonary fibrosis.

healthy human lungs 3D

What is Ventilation/Perfusion (V/Q) Mismatch?

To discuss the condition called V/Q mismatch, it’s important to understand what V/Q means:

  • The V means ventilation. We breathe air through our nose and mouth, through the trachea and down inside the bronchi. The air then travels down through small airways known as alveoli, where oxygen and carbon dioxide are exchanged.
  • The Q means perfusion. Also known as blood flow, perfusion takes place when deoxygenated blood (blue) travels through the pulmonary arteries through vessels to the capillaries, where the blood exchanges nutrients and becomes oxygenated.

When we breathe, our lungs work to transfer the air from our body and the environment (ventilation). As we ventilate, our lungs work to oxygenate our blood when it passes through the lungs (perfusion). V/Q or ventilation/perfusion refers to the amount of air that contacts the alveoli divided by the blood that flows to the lungs through the capillaries. V/Q mismatch happens when ventilation and perfusion don’t match up evenly and is a symptom of many pulmonary diseases.

What is Dead Space?

In some areas of the lungs, the capillaries and alveoli don’t line up, which is known as “dead space.” In anatomical dead space, there is an obstruction of either the blood supply or the airways. In the case when a foreign body is inhaled into the lungs, there would be no ventilation in that section of the lung where the airway is blocked and in case of a pulmonary embolism, there would be no perfusion in that section of the lung that the blood vessel feeds into. Physiological dead space happens when the structures of the blood vessels and airways are healthy, but the capillaries and alveoli don’t match up due to another reason like shunting of blood away from an area in the lungs. Dead space happens when you bring blood into a region where it is unable to extract oxygen from the airways. 

woman coughing into hand

What it Means to Have a V/Q Mismatch

If someone has V/Q mismatch, it means that the alveoli and capillaries don’t line up in some places inside of their lungs. There could be a lower volume of blood going into areas of high ventilation so that blood gets fully saturated with oxygen and there could be a larger volume of blood going into areas of low ventilation which results in the blood not being fully saturated with oxygen. This could be because some places in the lung have more capillaries than alveoli or that those areas are better perfused than ventilated. Other areas may have more alveoli with new oxygen than capillaries to grab that oxygen. These areas are better ventilated than perfused. So when blood with different levels of oxygenation come together in a larger vessel, there is a mismatch in the oxygenation and total blood oxygen decreases that is, it results in hypoxemia.

It is normal for the lungs to have a certain degree of mismatch, but if it increases significantly, it can cause problems. One of the most significant problems associated with a V/Q mismatch is the potential for it to cause hypoxemia and respiratory failure. Hypoxemia refers to the decrease of oxygen in the blood, which is something that people with pulmonary fibrosis often suffer from.  When the body’s cells are deprived of oxygen due to hypoxemia, it can cause symptoms like shortness of breath, confusion, faintness or even death.

puzzle piece lung operation

What Causes V/Q Mismatch?

V/Q mismatch is usually caused by an issue with the lungs that decreases or increases ventilation or perfusion. This means anything that interferes with the lung’s ability to receive fresh air into the alveoli or anything that prevents blood from flowing to the capillaries. Either of these circumstances has the potential to disrupt the balance between perfusion and ventilation, resulting in V/Q mismatch. Although most people who suffer from pulmonary fibrosis don’t experience V/Q mismatch, the scar tissue, collagen and inflammatory cells in the lungs associated with interstitial lung diseases like PF can cause an imbalance between perfusion and ventilation.

A decreased V/Q ratio where there is a decrease in ventilation or an increase in perfusion is often caused by conditions like asthma, chronic bronchitis, pulmonary edema and airway obstruction. An increased V/Q ratio where there is an increase in ventilation or a decrease in perfusion is often caused by conditions such as pulmonary embolism and emphysema.

The good news is, V/Q mismatch which results in hypoxemia can be overcome with oxygen supplementation. 

Never disregard professional medical advice or delay in seeking it because of any information received from us.

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