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

• 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
• ISSN: 1073-449X; 1535-4970
• DOI: 10.1164/rccm.201801-0095PP

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.