Chronic Obstructive Pulmonary Disease

Biography

Biography: Monika Szturmowicz

Abstract

Pulmonary hypertension (PH) defined as mean resting pulmonary artery pressure (mPAP) equal or higher than 25 mmHg ( measured directly), is found in 50% of the patients with end-stage COPD. In most cases mild PH is observed. Nevertheless in 2-7% of patients, severe PH (defined as mPAP>35 mmHg or CI<2.5 l/min) develops. What’s most interesting, severe PH in COPD is not always combined with end-stage disease. The differential diagnosis on such occassion should exclude the influence of other comorbidities on PH ( left heart disease, venous thromboembolism and sleep disordered breathing). Latest publications indicate that clinical phenotype of severe PH in COPD is characterised by: profound hypoxemia, hypocapnia and very low diffusion capacity of the lung for carbon dioxide (DLCO), despite mild or moderate aiway obstruction. It is still not known, if such phenotype is combined with certain genetic rearangements. According to latest PH guidelines, optimal COPD treatment combined with long therm oxygen therapy in the patients with PaO2 below 60 mmHg, is indicated in PH-COPD. Nevertheless in the patients with servere PH, the referral to an expert center is advised. Latest results of clinical trials with PH-specific drugs are disappointing. Despite the improvement in pulmonary haemodynamics, no significant changes in exercise capacity or quality of life of the patients are reported. Future research should be directed towards the identification of those PH-COPD patients, in whom maximal exercise capacity is limited by low cardiac output, and not by the exhaused ventilatory reserve.