Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comment
. 2001 Dec;5(6):286-9.
doi: 10.1186/cc1049. Epub 2001 Nov 3.

Pulmonary hypertension associated with COPD

R Naeije  1 , J A Barberà
Affiliations
Comment

Pulmonary hypertension associated with COPD

R Naeije et al. Crit Care. 2001 Dec.

Abstract

Pulmonary hypertension is a common complication of chronic obstructive pulmonary disease (COPD). The increase in pulmonary artery pressures is often mild to moderate, but some patients may suffer from severe pulmonary hypertension, and present with a progressively downhill clinical course because of right-sided heart failure added to ventilatory handicap. The cause of pulmonary hypertension in COPD is generally assumed to be hypoxic pulmonary vasoconstriction leading to permanent medial hypertrophy. However, recent pathological studies point, rather, to extensive remodeling of the pulmonary arterial walls, with prominent intimal changes. These aspects account for minimal reversibility with supplemental oxygen. There may be a case for pharmacological treatment of pulmonary hypertension in selected patients with advanced COPD and right-sided heart failure. Candidate drugs include prostacyclin derivatives, endothelin antagonists and inhaled nitric oxide, all of which have been reported of clinical benefit in primary pulmonary hypertension. However, it will be a challenge for randomized controlled trials to overcome the difficulties of the diagnosis of right ventricular failure and the definition of a relevant primary endpoint in pulmonary hypertensive COPD patients.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Optic-microscopic view of a pulmonary artery from a patient with pulmonary hypertension secondary to COPD. All three vessel wall layers are remodeled, with prominent intimal thickening.
Figure 2
Figure 2
Relations between mean pulmonary artery pressure (Ppa) minus left atrial pressure (Pla) and pulmonary blood flow in a representative patient with COPD at rest (A) and at exercise (C), redrawn from reference 9. Dobutamine is supposed to induce a passive increase in flow. Pulmonary vascular resistance (PVR) is the slope of the (Ppa-Pla)/Q relation. Passive increases in flow (A to B and C to D) increase pressure less than predicted by the PVR equation. Exercise (A to C and B to D) increases pressure more than predicted by the PVR equation.
See this image and copyright information in PMC

Comment on

References

    1. Vizza CD, Della Rocca G, Di Roma A, Iacobini C, Pierconti F, Venuta F, Rendina E, Schmid G, Pietropaoli P, Fedele F. Acute hemodynamic effects of inhaled nitric oxide, dobutamine, and their combination in patients with mild to moderate secondary pulmonary hypertension. Crit Care. 2002. - PMC - PubMed
    1. Wilkinson M, Langhorn CA, Heath D, Barer GR, Howard P. A pathophysiological study of 10 cases of hypoxic cor pulmonale. Q J Med. 1988;66:65–85. - PubMed
    1. Peinado VI, Barbera JA, Abate P, Ramirez J, Roca J, Santos S, Rodriguez-Roisin R. Inflammatory reaction in pulmonary muscular arteries of patients with mild chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 1999;59:1605–1611. - PubMed
    1. Heath D, Williams DR. Pulmonary hypertension. In High-Altitude Medicine and Pathology London: Butterworths, 1989. pp. 102–114.
    1. Lejeune P, Mols P, Naeije R, Hallemans R, Mélot C. Acute hemodynamic effects of controlled oxygen therapy in decompensated chronic obstructive pulmonary disease. Crit Care Med. 1984;12:1032–1035. - PubMed

MeSH terms

Substances