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Out of proportion pulmonary hypertension in obstructive lung diseases

Out of proportion pulmonary hypertension in obstructive lung diseases Purpose of reviewPulmonary hypertension is common (25–90%) in chronic obstructive pulmonary diseases (COPDs). Severe pulmonary hypertension, however, is quite rare (1–3%). The term ‘out of proportion’ pulmonary hypertension is still widely used. New guidelines instead propose to use the term ‘Severe pulmonary hypertension’ if mean pulmonary arterial pressure at least 35 mmHg or cardiac index (CI) is less than 2.0 l/min/m2 on right heart catheterization (RHC). Why only a minority of COPD patients develop severe pulmonary hypertension is unclear.Recent findingsWhen present, severe pulmonary hypertension in COPD is associated with increased dyspnea and decreased survival and often does not closely correlate with degree of obstructive abnormality on pulmonary function testing. COPD patients with severe pulmonary hypertension experience circulatory limitation at maximum exercise, and not ventilatory limitation, which is typical for moderate-to-severe COPD patients with no or moderate pulmonary hypertension.SummaryThere is no conclusive evidence to support or completely reject the possibility of the use of specific pulmonary arterial hypertension (PAH) therapies in pulmonary hypertension associated with COPD. In mild-to-moderate COPD patients who have severe and progressive symptoms, and have evidence of severe pulmonary hypertension on RHC, specific PAH therapies may be used similar to WHO group-I PAH guidelines. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Current Opinion in Pulmonary Medicine Wolters Kluwer Health

Out of proportion pulmonary hypertension in obstructive lung diseases

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Publisher
Wolters Kluwer Health
Copyright
Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
ISSN
1070-5287
eISSN
1531-6971
DOI
10.1097/MCP.0000000000000457
Publisher site
See Article on Publisher Site

Abstract

Purpose of reviewPulmonary hypertension is common (25–90%) in chronic obstructive pulmonary diseases (COPDs). Severe pulmonary hypertension, however, is quite rare (1–3%). The term ‘out of proportion’ pulmonary hypertension is still widely used. New guidelines instead propose to use the term ‘Severe pulmonary hypertension’ if mean pulmonary arterial pressure at least 35 mmHg or cardiac index (CI) is less than 2.0 l/min/m2 on right heart catheterization (RHC). Why only a minority of COPD patients develop severe pulmonary hypertension is unclear.Recent findingsWhen present, severe pulmonary hypertension in COPD is associated with increased dyspnea and decreased survival and often does not closely correlate with degree of obstructive abnormality on pulmonary function testing. COPD patients with severe pulmonary hypertension experience circulatory limitation at maximum exercise, and not ventilatory limitation, which is typical for moderate-to-severe COPD patients with no or moderate pulmonary hypertension.SummaryThere is no conclusive evidence to support or completely reject the possibility of the use of specific pulmonary arterial hypertension (PAH) therapies in pulmonary hypertension associated with COPD. In mild-to-moderate COPD patients who have severe and progressive symptoms, and have evidence of severe pulmonary hypertension on RHC, specific PAH therapies may be used similar to WHO group-I PAH guidelines.

Journal

Current Opinion in Pulmonary Medicine – Wolters Kluwer Health

Published: Mar 1, 2018

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