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hypertension due to hypoventilation or a patient with late diagnosed pulmonary arterial hypertension and consecutive respiratory failure. The treatment is different.Another open question is how to treat patients with hypoventilation due to hypoventilation and residual pulmonary hypertension following noninvasive positive-pressure ventilation. Is this a vascular abnormality with a prognostic impact? Perhaps a look at cardiac index might be helpful.For patients with pulmonary hypertension and lung disease, the current statement of the international conference on pulmonary hypertension recommends to separate patients with a predominantly exhausted circulatory or ventilatory reserve [4]. This is difficult in patients with severe pulmonary hypertension and hypoventilation. As we showed, these patients present with a high minute ventilation/carbon dioxide output slope but low respiratory exchange ratio and increasing end-tidal carbon dioxide tension reflecting a pattern which is different to that seen in patients with pulmonary arterial hypertension and patients with pure ventilatory impairment [1].V. Cottin and co-workers encourage us to treat the underlying disease as stated in our study [1]. However, we believe that an additional prospective study is needed in order to obtain a clear idea of how to manage these specific patients with residual pulmonary hypertension despite effective noninvasive positive-pressure ventilation.@ERSpublications Effects of PH-specific drugs on persistent PH after effective NIPPV are unclear and should be studied prospectively http://ow.ly/xnN4k The cost of tuberculosis sequelaeTo the Editor:We read with great interest the article by DIEL et al.[1], which analysed the total average cost of tuberculosis (TB) per case for the current 27 member states of the European Union (EU-27). The average combined direct and indirect cost of TB in the original EU-15 (Austria, Belgium, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Luxembourg, the Netherlands, Portugal, Spain, Sweden and the UK), plus Cyprus, Malta and Slovenia (EU-18), was calculated to be J10 282 for drug-susceptible TB, J57 213 for multidrugresistant TB (MDR-TB) and J170 744 for extensively drug-resistant TB (XDR-TB). According to differences in the gross domestic product, the total average cost in the remaining nine countries was extrapolated to be one-third of the mean cost in the EU-18: J3427 for drug-susceptible TB and J24 166 for MDR-TB/XDR-TB. When taking into account the 103 104 disability-adjusted life years caused by TB, the total cost of treating TB patients in the EU-27 in 2012 was estimated to be .J5 billion [1].As acknowledged by DIEL et al.[1], there are various limitations associated with their estimation of the total cost of TB in the EU-27. One of the limitations is that although the disability weight of TB (0.271) might
hypertension due to hypoventilation or a patient with late diagnosed pulmonary arterial hypertension and consecutive respiratory failure. The treatment is different.Another open question is how to treat patients with hypoventilation due to hypoventilation and residual pulmonary hypertension following noninvasive positive-pressure ventilation. Is this a vascular abnormality with a prognostic impact? Perhaps a look at cardiac index might be helpful.For patients with pulmonary hypertension and lung disease, the current statement of the international conference on pulmonary hypertension recommends to separate patients with a predominantly exhausted circulatory or ventilatory reserve [4]. This is difficult in patients with severe pulmonary hypertension and hypoventilation. As we showed, these patients present with a high minute ventilation/carbon dioxide output slope but low respiratory exchange ratio and increasing end-tidal carbon dioxide tension reflecting a pattern which is different to that seen in patients with pulmonary arterial hypertension and patients with pure ventilatory impairment [1].V. Cottin and co-workers encourage us to treat the underlying disease as stated in our study [1]. However, we believe that an additional prospective study is needed in order to obtain a clear idea of how to manage these specific patients with residual pulmonary hypertension despite effective noninvasive positive-pressure ventilation.@ERSpublications Effects of PH-specific drugs on persistent PH after effective NIPPV are unclear and should be studied prospectively http://ow.ly/xnN4k The cost of tuberculosis sequelaeTo the Editor:We read with great interest the article by DIEL et al.[1], which analysed the total average cost of tuberculosis (TB) per case for the current 27 member states of the European Union (EU-27). The average combined direct and indirect cost of TB in the original EU-15 (Austria, Belgium, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Luxembourg, the Netherlands, Portugal, Spain, Sweden and the UK), plus Cyprus, Malta and Slovenia (EU-18), was calculated to be J10 282 for drug-susceptible TB, J57 213 for multidrugresistant TB (MDR-TB) and J170 744 for extensively drug-resistant TB (XDR-TB). According to differences in the gross domestic product, the total average cost in the remaining nine countries was extrapolated to be one-third of the mean cost in the EU-18: J3427 for drug-susceptible TB and J24 166 for MDR-TB/XDR-TB. When taking into account the 103 104 disability-adjusted life years caused by TB, the total cost of treating TB patients in the EU-27 in 2012 was estimated to be .J5 billion [1].As acknowledged by DIEL et al.[1], there are various limitations associated with their estimation of the total cost of TB in the EU-27. One of the limitations is that although the disability weight of TB (0.271) might
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