Pulmonary hypertension in lung diseases: survey of beliefs and practice patterns

Pulmonary hypertension can be associated with decreased functional capacity and poor prognosis in patients with parenchymal lung diseases (PLD). Yet, little attention has been given to current beliefs and practice patterns.

An 18-question survey was submitted electronically to members of four Networks of the American College of Chest Physicians.

Analyzable responses were received from 453 physicians. Most (95%) respondents reported testing for PH in patients with PLD using transthoracic echocardiography (TTE) or right-heart catheterization (RHC) and believed that PH could occur in the absence of severe compromise in pulmonary function (70%) and hypoxemia (50%). Approximately 30% of physicians reported not performing RHC to confirm a diagnosis of PH before initiating therapy. Most respondents (92%) felt that medical therapy was effective and the medication of first choice was either bosentan or sildenafil. Most respondents believed that treating PH in these patients improves quality of life (63%) and dyspnea (67%), but were less sure about the impact on functional capacity and survival.

Approximately 30% of physicians do not perform RHC to confirm this diagnosis prior to initiating therapy. Despite relatively little supportive evidence, most physicians treat with vasoactive medications and believe that medical therapy confers benefit.