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Assessing pulmonary hypertension severity in lung disease is a key step to improving outcomes: embrace resistance and don't be pressurised to go with the flow

David G. Kiely, Robin Condliffe
European Respiratory Journal 2021 58: 2102008; DOI: 10.1183/13993003.02008-2021
David G. Kiely
1Dept of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
2Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
3INSIGNEO, Institute for In Silico Medicine, University of Sheffield, Sheffield, UK
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  • For correspondence: david.kiely1@nhs.net
Robin Condliffe
1Dept of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
2Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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Extract

Managing patients with pulmonary hypertension (PH) in association with chronic lung disease and/or hypoxia (PH-CLD) remains one of the most challenging areas in pulmonary vascular medicine. Its presence in COPD and interstitial lung disease (ILD) impacts negatively on symptoms and survival [1, 2], predicts more frequent exacerbations [3] and has the worst prognosis of all forms of PH [4]. In contrast to treatment advances seen in other forms of PH, for the majority of patients with PH-CLD, treatment remains aimed at the underlying lung disease, including lung transplantation in suitable patients. One of the major challenges to evaluating new therapies in PH-CLD relates to the heterogeneity of pulmonary vascular involvement.

Abstract

In patients with lung disease and pulmonary hypertension, measures of resistance (pulmonary vascular resistance) and not flow (cardiac index) should be used to assess for severe pulmonary hypertension https://bit.ly/3xaL0mk

Footnotes

  • Conflict of interest: D.G. Kiely reports grants, personal fees and funds for meeting attendance from Janssen and GSK, personal fees and funds for meeting attendance from MSD, personal fees from Acceleron, outside the submitted work.

  • Conflict of interest: R. Condliffe reports personal fees and funds for meeting attendance from Janssen, GSK and MSD, outside the submitted work.

  • Received July 19, 2021.
  • Accepted July 21, 2021.
  • Copyright ©The authors 2021. For reproduction rights and permissions contact permissions{at}ersnet.org
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Vol 58 Issue 2 Table of Contents
European Respiratory Journal: 58 (2)
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Assessing pulmonary hypertension severity in lung disease is a key step to improving outcomes: embrace resistance and don't be pressurised to go with the flow
David G. Kiely, Robin Condliffe
European Respiratory Journal Aug 2021, 58 (2) 2102008; DOI: 10.1183/13993003.02008-2021

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Assessing pulmonary hypertension severity in lung disease is a key step to improving outcomes: embrace resistance and don't be pressurised to go with the flow
David G. Kiely, Robin Condliffe
European Respiratory Journal Aug 2021, 58 (2) 2102008; DOI: 10.1183/13993003.02008-2021
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  • Article
    • Abstract
    • Introduction
    • Identifying patients with PH-CLD with a pulmonary vascular phenotype
    • Is it time to update the definition for haemodynamic severity in PH-CLD?
    • PAH therapies in ILD
    • PAH therapies in COPD
    • Improving outcomes for patients with PH-CLD: refining patient phenotyping
    • Conclusion
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