title: Pulmonary hypertension in chronic obstructive and interstitial lung diseases.
abstract: The purpose of the present review is to summarize the current knowledge on PH in relation to COPD and ILD from a clinical perspective with emphasis on diagnosis, biomarkers, prevalence, impact, treatment, and practical implications. PH in COPD and ILD is associated with a poor prognosis, and is considered one of the most frequent types of PH. However, the prevalence of PH among patients with COPD and ILD is not clear. The diagnosis of PH in chronic lung disease is often established by echocardiographic screening, but definitive diagnosis requires right heart catheterization, which is not systematically performed in clinical practice. Given the large number of patients with chronic lung disease, biomarkers to preclude or increase suspicion of PH are needed. NT-proBNP may be used as a rule-out test, but biomarkers with a high specificity for PH are still required. It is not known whether specific treatment with existent drugs effective in pulmonary arterial hypertension (PAH) is beneficial in lung disease related PH. Studies investigating existing PAH drugs in animal models of lung disease related PH have indicated a positive effect, and so have case reports and open label studies. However, treatment with systemically administered pulmonary vasodilators implies the risk of worsening the ventilation-perfusion mismatch in patients with lung disease. Inhaled vasodilators may be better suited for PH in lung disease, but new treatment modalities are also required.
authors.affiliation: Department of Clinical Pharmacology, Aarhus University Hospital, Denmark. Electronic address: cua@farm.au.dk.
authors.forename: Charlotte U
authors.initials: CU
authors.lastname: Andersen
authors.forename: Søren
authors.initials: S
authors.lastname: Mellemkjær
authors.forename: Jens Erik
authors.initials: JE
authors.lastname: Nielsen-Kudsk
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Bendstrup
authors.forename: Ole
authors.initials: O
authors.lastname: Hilberg
authors.forename: Ulf
authors.initials: U
authors.lastname: Simonsen
mesh_terms: D000818:Animals; D015415:Biomarkers / Q000378:metabolism; D003952:Diagnostic Imaging; D018450:Disease Progression; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D017563:Lung Diseases, Interstitial / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology; D011379:Prognosis; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology; D011669:Pulmonary Wedge Pressure
chemical_list: D015415:Biomarkers
keywords: 6min walk test; Biomarkers; Chronic lung disease; NT-proBNP; Pulmonary hypertension; Troponin-T