Pulmonary Vascular Involvement in Chronic Obstructive Pulmonary Disease. Is There a Pulmonary Vascular Phenotype?

The symptoms of such patients cannot be explained by lung mechanical disturbances alone. Because it is not always easy to distinguish patients with PAH and COPD (group 1) from patients with PH caused by COPD (group 3), the Fifth World Symposium on Pulmonary Hypertension suggested some specific diagn...

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Bibliographic Details
Published in:American journal of respiratory and critical care medicine 2018-10, Vol.198 (8), p.1000-1011
Main Authors: Kovacs, Gabor, Agusti, Alvar, Barberà, Joan Albert, Celli, Bartolome, Criner, Gerard, Humbert, Marc, Sin, Don D, Voelkel, Norbert, Olschewski, Horst
Format: Article
Language:English
Subjects:
Airway management
Chronic obstructive pulmonary disease
Emphysema
Gene expression
Genotype & phenotype
Growth factors
Life Sciences
Lung diseases
Lungs
Nitric oxide
Pulmonary arteries
Pulmonary hypertension
Respiration
Smoking
Smooth muscle
Veins & arteries
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Summary:The symptoms of such patients cannot be explained by lung mechanical disturbances alone. Because it is not always easy to distinguish patients with PAH and COPD (group 1) from patients with PH caused by COPD (group 3), the Fifth World Symposium on Pulmonary Hypertension suggested some specific diagnostic criteria to aid clinicians in the differential diagnosis. [...]about 50% of patients with COPD selected for lung transplant or lung volume reduction surgery had mPAP values greater than 25 mm Hg (52, 58, 64, 65). According to current guidelines (51), potential indications for RHC in advanced lung disease include 1) proper diagnosis or exclusion of PH in candidates for surgical treatments (transplant, lung volume reduction), 2) suspected PAH or chronic thromboembolic pulmonary hypertension, 3) episodes of right ventricular failure, and 4) inconclusive echocardiographic findings in cases with a high level of suspicion and potential therapeutic implications. [...]besides the small cohort of patients with COPD with the pulmonary vascular phenotype, there may be a much larger, clinically heterogeneous group of patients with COPD with mild pulmonary vascular disease but a steep PAP increase during exercise, causing severe dyspnea.
ISSN:1073-449X
1535-4970
DOI:10.1164/rccm.201801-0095PP