Severe pulmonary hypertension in patients with COPD
Purpose of Review: The possible development of pulmonary hypertension is a well-known complication in the course of chronic obstructive pulmonary disease. When present, pulmonary hypertension is in general of mild severity at rest. It is therefore generally considered as a second-rank marker of the disease, mainly because the patients are limited in their exercise capacity for respiratory rather than for circulatory reasons. Apart from the common hemodynamic profile, however, some patients have a moderate-to-severe level of mean pulmonary artery pressure.
Recent Findings: These patients with a predominant vascular disease have been individualized recently. They have in common some particularities, the most characteristic profile being a mild-to-moderate airway obstruction, contrasting with the severity of dyspnea and hypoxemia. Another typical feature in these patients is the apparently poor prognosis.
Summary: Such patients have to be recognized because they are potential candidates for specific therapies aiming at reducing pulmonary vascular resistance.
That chronic obstructive pulmonary disease (COPD) can lead to pulmonary hypertension (PH) and cor pulmonale has long been established. Apart from the usual pattern of PH, which will be discussed in the first part of this review, some patients also present with a much higher level of mean pulmonary artery pressure (mPAP). The second part of the review will focus more particularly on these patients with a predominant pulmonary vascular disease.
Purpose of Review: The possible development of pulmonary hypertension is a well-known complication in the course of chronic obstructive pulmonary disease. When present, pulmonary hypertension is in general of mild severity at rest. It is therefore generally considered as a second-rank marker of the disease, mainly because the patients are limited in their exercise capacity for respiratory rather than for circulatory reasons. Apart from the common hemodynamic profile, however, some patients have a moderate-to-severe level of mean pulmonary artery pressure.
Recent Findings: These patients with a predominant vascular disease have been individualized recently. They have in common some particularities, the most characteristic profile being a mild-to-moderate airway obstruction, contrasting with the severity of dyspnea and hypoxemia. Another typical feature in these patients is the apparently poor prognosis.
Summary: Such patients have to be recognized because they are potential candidates for specific therapies aiming at reducing pulmonary vascular resistance.
That chronic obstructive pulmonary disease (COPD) can lead to pulmonary hypertension (PH) and cor pulmonale has long been established. Apart from the usual pattern of PH, which will be discussed in the first part of this review, some patients also present with a much higher level of mean pulmonary artery pressure (mPAP). The second part of the review will focus more particularly on these patients with a predominant pulmonary vascular disease.
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