Update on pulmonary hypertension complicating chronic obstructive pulmonary disease

Figures & data

Figure 1 Potential mechanisms leading to pulmonary hypertension in COPD.

Abbreviation: COPD, chronic obstructive pulmonary disease.

Table 1 Conditions associated with pulmonary hypertension

Heart failure (Systolic/Diastolic)	Dyspnea, exercise intolerance, angina, prior myocardial infarctions, systemic hypertension, valvular heart disease
Current smoking	Smoking cessation counseling, nicotine replacement therapy
Obstructive sleep apnea	Snoring, excessive somnolence, witnessed apneic episodes
Autoimmune diseases	History of skin changes, arthritis, gastrointestinal problems and renal disease
Chronic thromboembolic disease	Prior history of pulmonary embolism, deep vein thrombosis and genetic or acquired hypercoagulable conditions
Drug history	Illicit drug abuse, prior anorexiant use and herbal products
Chronic liver disease	History of jaundice, ascites, chronic viral hepatitis and alcohol abuse. Symptoms of portal hypertension including abdominal distention, and gastrointestinal bleed
HIV infection	Sexual behavior, intravenous drug abuse and needle sharing
Congenital diseases	History of congenital heart disease and intracardiac shunts, family history of sickle cell disease

Table 2 Summary of few studies to treat COPD-related PH

Study	Agent	Result	Comment
Nocturnal Oxygen Treatment Trial (NOTT)^Citation60	Oxygen	Decrease in PVR with continuous oxygen supplementation	Survival benefit with continuous oxygen use with reduction in PVR and hematocrit
Medical Research Council (MRC) trial^Citation61	Oxygen	PAP stable with O2 supplementation compared to increase noted with room air	Survival benefit after 500 days of oxygen use
Zielinski J et al^Citation67	Oxygen	Initial fall and subsequent stabilization of PAP with long term oxygen therapy	Worsening airway disease in presence of long term oxygen therapy
Vonbank et al^Citation69	Inhaled NO + oxygen	Improved PAP and PVR after three months of pulsed NO inhalation	Short study duration. Needs validation in long term studies
Alp et al^Citation75	Sildenafil	Improvement in PAP, PVR and 6MWT acutely and after three months	Small subject population with six initially and five after three months follow-up
Valerio G et al^Citation78	Bosentan	Improvement in PAP, PVR, and 6MWD after 18 months	Small subject population of 16 patients

Figure 2 Diagnostic approach to a COPD patient with suspected PH.

Abbreviations: COPD, chronic obstructive pulmonary disease; PH, pulmonary hypertension.

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