Current trends in the management of pulmonary hypertension associated with respiratory disease in institutions approved by the Japanese Respiratory Society.
BACKGROUND
Pulmonary hypertension (PH) often correlates with respiratory disease severity. Right heart catheterization (RHC) is recommended for the definitive diagnosis of PH associated with respiratory disease (R-PH). However, no previous studies have evaluated the perceived necessity for pulmonologists to use RHC for R-PH diagnosis, or the management of R-PH in Japan.


METHODS
Questionnaires were mailed to 855 institutions, approved by the Japanese Respiratory Society. Questions included the prevalence and necessity of RHC and other methods in R-PH diagnosis, and current trends in the treatment of R-PH.


RESULTS
Questionnaires were returned from 289 institutions (34%). Patients with R-PH were examined by pulmonologists in 89% of institutions; some pulmonologists performed echocardiography (15%) and some RHC (13%). Echocardiography was used to diagnose R-PH in 99% of institutions and RHC was used in 36%. RHC was considered in cases of suspected PH in 49% of institutions and prior to initiation of pulmonary arterial hypertension (PAH)-specific therapy in 57%. Of patients diagnosed with R-PH, 47% were treated with ambulatory oxygen therapy. Furthermore, 98 of 145 institutions used PAH-specific therapy to treat R-PH. Of the 1355 patients who underwent RHC as a part of PH evaluation, 29% were confirmed to have PH, and 8% had severe PH with a mean pulmonary arterial pressure of ≥35mmHg.


CONCLUSIONS
The current diagnostic and treatment modalities for R-PH in Japan were evaluated. Although few pulmonologists perform RHC for R-PH diagnosis in Japan, more than half consider using RHC for patients before initiating PAH-specific therapy.
Department of Respirology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana Chuou-ku, Chiba 260-8670, Japan; Pulmonary Circulation/Lung Injury Assembly of the Japanese Respiratory Society, Tokyo 113-0013, Japan. Electronic address: ntanabe@faculty.chiba-u.jp.
Nobuhiro
N
Tanabe
Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Aichi 489-8642, Japan. Electronic address: taniguchi@tosei.or.jp.
Hiroyuki
H
Taniguchi
First Department of Medicine, Hokkaido University Hospital, Sapporo 060-8648, Japan. Electronic address: itsujino@nifty.com.
Ichizo
I
Tsujino
Department of Medicine, Tokyo Saiseikai Central Hospital, Tokyo 108-0073, Japan. Electronic address: fsakamak@saichu.jp.
Fumio
F
Sakamaki
Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan. Electronic address: noriaki.emoto@mac.com.
Noriaki
N
Emoto
Second Department of Internal Medicine, Nara Medical University, Kashihara 634-8522, Japan. Electronic address: kimura@nmu-gw.naramed-u.ac.jp.
Hiroshi
H
Kimura
Division of Cardiology, National Hospital Organization Okayama Medical Center, Okayama 701-1192, Japan. Electronic address: gmigyag@gmail.com.
Katsumasa
K
Miyaji
First Department of Medicine, Obihiro-Kosei General Hospital, Obihiro, 080-0016, Japan. Electronic address: keitak@hokkaido.med.or.jp.
Kei
K
Takamura
Department of Respiratory Medicine, Nihon University School of Medicine, Tokyo 173-8610, Japan. Electronic address: hayashi.shinichi@nihon-u.ac.jp.
Shinichi
S
Hayashi
First Department of Medicine, Shinshu University School of Medicine, Matsumoto 390-0802, Japan. Electronic address: masayuki@shinshu-u.ac.jp.
Masayuki
M
Hanaoka
Department of Respirology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana Chuou-ku, Chiba 260-8670, Japan; Pulmonary Circulation/Lung Injury Assembly of the Japanese Respiratory Society, Tokyo 113-0013, Japan. Electronic address: tatsumi@faculty.chiba-u.jp.
Koichiro
K
Tatsumi
D000047:Academies and Institutes / Q000706:statistics & numerical data; D062186:Arterial Pressure; D006328:Cardiac Catheterization / Q000706:statistics & numerical data*; D019468:Disease Management; D004452:Echocardiography / Q000706:statistics & numerical data; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications* / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D007564:Japan; D010102:Oxygen Inhalation Therapy / Q000706:statistics & numerical data; D011651:Pulmonary Artery / Q000503:physiopathology; D015272:Pulmonary Medicine / Q000458:organization & administration*; D012140:Respiratory Tract Diseases / Q000150:complications* / Q000175:diagnosis; D012720:Severity of Illness Index; D012955:Societies, Medical / Q000458:organization & administration*; D011795:Surveys and Questionnaires
Chronic obstructive pulmonary disease; Pulmonary hypertension; Pulmonologist; Respiratory disease; Right heart catheterization