Hypoxic Pulmonary Vasoconstriction and Gas Exchange During Exercise in Chronic Obstructive Pulmonary Disease

Agustí, Àlvar; Barberà, Joan Albert; Roca, Josep; Wagner, Peter D.; Guitart, Raimón; Rodríguez-Roisín, Robert

doi:10.1378/chest.97.2.268

Cited by 141 publications

(110 citation statements)

References 8 publications

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“…Treatment with conventional vasodilators such as CCBs is not recommended because they may impair gas exchange due to the inhibition of hypoxic pulmonary vasoconstriction [406][407][408] and because of their lack of efficacy after long-term use [409,410].…”

Section: Therapymentioning

confidence: 99%

2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension

et al. 2015

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Guidelines summarize and evaluate all available evidence on a particular issue at the time of the writing process, with the aim of assisting health professionals in selecting the best management strategies for an individual patient with a given condition, taking into account the impact on outcome, as well as the risk–benefit ratio of particular diagnostic or therapeutic means. Guidelines and recommendations should help health professionals to make decisions in their daily practice. However, the final decisions concerning an individual patient must be made by the responsible health professional(s) in consultation with the patient and caregiver as appropriate.

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Section: Therapymentioning

confidence: 99%

2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension

et al. 2015

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“…In interstitial lung diseases, the role of long-term O 2 therapy in PH progression is less clear. Treatment with conventional vasodilators is not recommended because they may impair gas exchange due to the inhibition of hypoxic pulmonary vasoconstriction [241,242] and their lack of efficacy after long-term use [243,244]. Published experience with specific PAH drug therapy is scarce and consists of the assessment of acute effects [245,246] and uncontrolled studies in small series [247][248][249][250][251].…”

Section: Therapymentioning

confidence: 99%

Guidelines for the diagnosis and treatment of pulmonary hypertension

Galiè¹,

Hoeper²,

Humbert³

et al. 2012

Revista Portuguesa de Cardiologia (English Edition)

418

738

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“…These findings suggest that the impairment of endothelial function is associated with an altered response to hypoxic stimulus that further worsens gas exchange. The contribution of hypoxic vasoconstriction to gas exchange in COPD should be taken into account when administering drugs that might potentially inhibit such a response since they may also impair gas exchange [47][48][49][50].…”

Section: Hypoxic Pulmonary Vasoconstrictionmentioning

confidence: 99%

“…Patients that appear more prone to the development of pulmonary hypertension may show an abnormal increase in Ppa during exercise years before pulmonary hypertension is apparent at rest [13]. Different studies have identified a number of mechanisms for exercise-induced pulmonary hypertension in COPD, including hypoxic vasoconstriction, reduction of the capillary bed by emphysema, extramural compression by increased alveolar pressure or impaired release of endothelium-derived relaxing factors [14,19,49,65] that may combine and contribute to the development of pulmonary hypertension during exercise. In COPD patients, Ppa during exercise is greater than predicted by the PVR equation, suggesting active pulmonary vasoconstriction on exertion [49].…”

Section: Exercisementioning

confidence: 99%

Pulmonary hypertension in chronic obstructive pulmonary disease

Barberà

Peinado²,

Santos³

2003

Eur Respir J

385

299

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Pulmonary hypertension in chronic obstructive pulmonary disease. J.A. Barberà, V.I. Peinado, S. Santos. #ERS Journals Ltd 2003. ABSTRACT: Pulmonary hypertension is a common complication of chronic obstructive pulmonary disease (COPD). Its presence is associated with shorter survival and worse clinical evolution. In COPD, pulmonary hypertension tends to be of moderate severity and progresses slowly. However, transitory increases of pulmonary artery pressure may occur during exacerbations, exercise and sleep. Right ventricular function is only mildly impaired with preservation of the cardiac output.Structural and functional changes of pulmonary circulation are apparent at the initial stages of COPD. Recent investigations have shown endothelial dysfunction and changes in the expression of endothelium-derived mediators that regulate vascular tone and cell growth in the pulmonary arteries of patients with mild disease. Some of these changes are also present in smokers with normal lung function. Accordingly, it has been postulated that the initial event in the natural history of pulmonary hypertension in COPD could be the lesion of pulmonary endothelium by cigarettesmoke products.Long-term oxygen administration is the only treatment that slows down the progression of pulmonary hypertension in chronic obstructive pulmonary disease. Nevertheless, with this treatment pulmonary artery pressure rarely returns to normal values and the structural abnormalities of pulmonary vessels remain unaltered. Vasodilators are not recommended on the basis of their minimal clinical efficacy and because they impair pulmonary gas exchange. Recognition of the role of endothelial dysfunction in the physiopathology of pulmonary hypertension in chronic obstructive pulmonary disease opens new perspectives for the treatment of this complication. Eur Respir J 2003; 21: 892-905.

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Hypoxic Pulmonary Vasoconstriction and Gas Exchange During Exercise in Chronic Obstructive Pulmonary Disease

Cited by 141 publications

References 8 publications

2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension

2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension

Guidelines for the diagnosis and treatment of pulmonary hypertension

Pulmonary hypertension in chronic obstructive pulmonary disease

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