title: Peripheral airway obstruction in primary pulmonary hypertension.
abstract: BACKGROUND
  As there is controversy about changes in lung function in primary pulmonary hypertension (PPH), lung mechanics were assessed with a focus on expiratory airflow in relation to pulmonary haemodynamics.
  
  
  METHODS
  A cross sectional study was performed in 64 controls and 171 patients with PPH (117 women) of mean (SD) age 45 (13) years, pulmonary artery pressure (PAPmean) 57 (15) mm Hg, and pulmonary vascular resistance 1371 (644) dyne.s/cm(5).
  
  
  RESULTS
  Mean (SD) total lung capacity was similar in patients with PPH and controls (98 (12)% predicted v 102 (17)% predicted, mean difference -4 (95% confidence interval (CI) -7.89 to -0.11); residual volume (RV) was increased (118 (24)% predicted v 109 (27)% predicted, mean difference 9 (95% CI 1.86 to 16.14); and vital capacity (VC) was decreased (91 (16)% predicted v 102 (10)% predicted, mean difference -11 (95% CI 15.19 to -6.80). RV/TLC was increased (117 (27)% predicted v 97 (29)% predicted, mean difference 20 (95% CI 12.3 to 27.8)) and correlated with PAPmean (r=0.31, p<0.001). In patients with PAPmean above the median of 56 mm Hg, RV/TLC was further increased (125 (32)% predicted v 111 (22)% predicted, mean difference -14 (95% CI -22.2 to -5.8)). Expiratory flow-volume curves were reduced and curvilinear in patients with PPH.
  
  
  CONCLUSIONS
  Peripheral airway obstruction is common in PPH and is more pronounced in severe disease. This may contribute to symptoms. Reversibility of bronchodilation and relation to exercise capacity need further evaluation.
authors.affiliation: Department of Internal Medicine III, Ruprecht-Karls-University, Heidelberg, Germany.
authors.forename: F J
authors.initials: FJ
authors.lastname: Meyer
authors.forename: R
authors.initials: R
authors.lastname: Ewert
authors.forename: M M
authors.initials: MM
authors.lastname: Hoeper
authors.forename: H
authors.initials: H
authors.lastname: Olschewski
authors.forename: J
authors.initials: J
authors.lastname: Behr
authors.forename: J
authors.initials: J
authors.lastname: Winkler
authors.forename: H
authors.initials: H
authors.lastname: Wilkens
authors.forename: C
authors.initials: C
authors.lastname: Breuer
authors.forename: W
authors.initials: W
authors.lastname: Kübler
authors.forename: M M
authors.initials: MM
authors.lastname: Borst
mesh_terms: D000402:Airway Obstruction / Q000150:complications* / Q000503:physiopathology; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D005541:Forced Expiratory Volume / Q000502:physiology; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications* / Q000503:physiopathology; D008297:Male; D008448:Maximal Expiratory Flow Rate / Q000502:physiology; D008875:Middle Aged; D015656:Respiratory Mechanics; D014109:Total Lung Capacity / Q000502:physiology; D014797:Vital Capacity / Q000502:physiology