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Pulmonary hypertension in chronic obstructive pulmonary disease
J A Barberà1, V I Peinado, S Santos
1Dept of Pulmonary Medicine, Institute of Biomedical Research Augusti Pi i Sunyer (IDIBAPS), Hospital Clinic, University of Barcelona, Spain. jbarbera@clinic.ub.es
The European Respiratory Journal
|May 27, 2003
Summary
Pulmonary hypertension in chronic obstructive pulmonary disease (COPD) is linked to poor outcomes. Endothelial dysfunction, potentially caused by smoking, plays a key role, with oxygen therapy only slowing progression.
Area of Science:
- Pulmonary Medicine
- Cardiology
- Vascular Biology
Background:
- Pulmonary hypertension (PH) is a frequent complication of chronic obstructive pulmonary disease (COPD).
- PH in COPD is associated with reduced survival and poorer clinical outcomes.
- Early structural and functional changes in the pulmonary circulation are observed in COPD patients.
Purpose of the Study:
- To explore the role of endothelial dysfunction in the development of pulmonary hypertension in COPD.
- To investigate the impact of cigarette smoke on pulmonary endothelium.
- To review current treatment strategies for PH in COPD.
Main Methods:
- Review of recent investigations on endothelial dysfunction in COPD patients.
- Analysis of the effects of cigarette smoke on pulmonary arteries.
- Evaluation of the efficacy of long-term oxygen therapy and vasodilators.
Main Results:
- Endothelial dysfunction and altered expression of endothelium-derived mediators are present even in mild COPD and in smokers with normal lung function.
- Cigarette smoke products may initiate pulmonary hypertension in COPD.
- Long-term oxygen therapy slows PH progression but does not normalize pulmonary artery pressure or reverse structural changes.
- Vasodilators show minimal efficacy and can impair gas exchange.
Conclusions:
- Endothelial dysfunction is a critical factor in the pathophysiology of pulmonary hypertension in COPD.
- Understanding endothelial dysfunction opens new therapeutic avenues for managing PH in COPD.
- Current treatments like oxygen therapy have limitations in fully reversing the condition.