Medical treatment of pulmonary hypertension in chronic lung disease

In chronic respiratory diseases, especially chronic obstructive pulmonary disease (COPD) pulmonary arterial hypertension is generally mild to moderate and the necessity for treating it can, therefore, be questioned. In fact, pulmonary hypertension, even when modest, may worsen markedly during acute episodes, exercise and sleep. These acute increases in mean pulmonary artery pressure (PAP) could contribute to the development of right heart failure. Therefore, the medical treatment of pulmonary hypertension is justified. There are, at the present time, no selective pulmonary vasodilators, with the exception of inhaled nitric oxide. Indeed, vasodilators appear less effective in COPD compared to primary pulmonary hypertension. Thus, there is, at present, no justification for the long-term use of vasodilators in COPD patients. Long-term oxygen therapy (LTOT) attenuates and sometimes reverses the progression of pulmonary hypertension, although the condition rarely returns to normal. We do not know whether the structural changes of the pulmonary vasculature in COPD patients are potentially reversible with LTOT. The longer the daily duration of LTOT the better are the haemodynamic results. At present, LTOT remains the best treatment for pulmonary hypertension in COPD patient. In the future, treatment of this condition in COPD patients could combine LTOT and specific vasodilators.

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