Semin Respir Crit Care Med 2009; 30(4): 458-470
DOI: 10.1055/s-0029-1233315
© Thieme Medical Publishers

Pulmonary Hypertension in Chronic Obstructive Pulmonary Disease and Interstitial Lung Diseases

Emmanuel Weitzenblum1 , Ari Chaouat2 , Matthieu Canuet1 , Romain Kessler1
  • 1Department of Pulmonology, Nouvel Hôpital Civil, Strasbourg France
  • 2Department of Respiratory Diseases and Respiratory Intensive Care, CHU de Nancy, Nancy, France
Further Information

Publication History

Publication Date:
24 July 2009 (online)

ABSTRACT

Pulmonary hypertension (PH) is a common complication of chronic respiratory diseases and particularly of chronic obstructive pulmonary disease (COPD) and interstitial lung diseases (ILD). Owing to its frequency COPD is by far the most common cause of PH. It is generally a mild to moderate PH, pulmonary artery mean pressure (PAP) usually ranging between 20 and 25 mm Hg, but PH may worsen during exercise, sleep, and particularly during exacerbations of the disease. These acute increases in PAP may lead to the development of right heart failure. A small proportion of COPD patients may present “disproportionate” PH defined by a resting PAP >35 to 40 mm Hg. The prognosis is particularly poor in these patients. PH is relatively frequent in advanced ILD and particularly in idiopathic pulmonary fibrosis. As in COPD the diagnosis is suggested by Doppler echocardiography, but the confirmation still requires right heart catheterization. As in COPD, functional (alveolar hypoxia) and morphological factors (vascular remodeling, destruction of the pulmonary parenchyma) explain the elevation of pulmonary vascular resistance that leads to PH. Also as in COPD PH is most often mild to moderate. In ILD the presence of PH predicts a poor prognosis. The treatment of PH relies on long-term oxygen therapy. “New” vasodilator drugs have rarely been used in COPD and ILD patients exhibiting severe PH. In advanced ILD the presence of PH is a supplemental argument for considering lung transplantation.

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Emmanuel WeitzenblumM.D. 

Department of Pulmonology, Nouvel Hôpital Civil

67091 Strasbourg, France

Email: Emmanuel.weitzenblum@chru-strasbourg.fr

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