COPD-associated pulmonary hypertension: clinical implications and current methods for treatment

Abstract

Chronic obstructive pulmonary disease is the fourth leading cause of death worldwide, one serious complication being pulmonary hypertension, which occurs in up to 30% of patients and increases mortality drastically. Difficulties in diagnosis and the unclear beneficial effects of PH-specific therapy have hitherto resulted in the absence of approved therapies. Consequently, PH and right heart failure in COPD are still currently treated according to symptoms and not underlying cause Areas covered: This review focuses on the current knowledge of its pathogenesis, clinical picture, diagnosis as well as methods for treatment Expert commentary: Since PH-COPD is an orphan disease with grievous consequences, and diagnosis as well as the right choice of possible treatment is crucial, referral to an expert center in cases of suspicion is necessary. Hitherto there is no officially approved treatment available even though several studies have shown notable improvement in selected individuals, making diagnostics, prognostic markers, and the search for therapeutic agents key issues of interest in this field.

Clinical characteristics and predictors of pulmonary hypertension in chronic obstructive pulmonary disease at different altitudes

“…Regarding the role of inflammation in the development of PH in COPD patients, previous studies have shown that CRP, interleukin (IL)-1, and IL-6 levels were higher in COPD-PH patients than in COPD-NPH patients [ 45 – 47 ]. Grimminger J et al [ 48 ] showed that: (1) chronic inflammation could lead to endothelial dysfunction, reducing the levels of endothelium-derived relaxing factors (for example, nitric oxide and prostacyclin) and increasing the levels of endothelium-derived contracting factors (for example, reactive oxygen species and endothelin). (2) chronic inflammation could lead to loss of ciliary cell function and instability of the airways, leading to COPD and hypoxia, which is associated with endothelial dysfunction.…”

Prediction of long-term mortality by using machine learning models in Chinese patients with connective tissue disease-associated interstitial lung disease

“…Furthermore, the abnormal increase in AST and hypoalbuminemia have been shown to increase mortality in CTD-ILD patients [ 23 – 25 ]. Long-term hypoxia caused by gas exchange impairment may lead to an increase in pulmonary artery pressure and right ventricular afterload [ 26 ]. Right heart enlargement due to persistently increased afterload is a common cause of mortality in patients with ILD which is characterized by the increase of RVD and RAA [ 27 ].…”

Hypoxic mast cells accelerate the proliferation, collagen accumulation and phenotypic alteration of human lung fibroblasts

“…Pulmonary hypertension generally results from hypoxic lung diseases, such as chronic obstructive pulmonary disease (COPD), cystic fibrosis and bronchiectasis (1). Chronic hypoxia results in pulmonary hypertension, which is characterized by progressively elevated pulmonary arterial pressure, increased right ventricular afterload leading to right ventricular hypertrophy, ultimately resulting in heart failure (2,3).…”