Pulmonary hypertension-specific therapy in patients with chronic respiratory insufficiency

Abstract

beneficial in this setting. As stated at a recent international conference on PH, PH-specific drugs are not recommended in patients with PH associated with chronic respiratory diseases (group 3), and treatment should focus on managing the underlying disease [4]. Oxygen supplementation may stabilise PH in patients with COPD [5], and NIPPV may improve haemodynamics in patients with alveolar hypoventilation [1]. Although off-label treatment is sometimes considered in individuals with severe PH when functional limitation is considered to be related to pulmonary vascular disease, there is currently little if any evidence that PH therapy may be beneficial in this setting, with further anecdotal evidence that treatment may increase hypoxaemia through ventilation/perfusion mismatch.We therefore strongly agree with HELD et al.[1] that correction of hypoventilation should be the main objective of management in chronic respiratory insufficiency, even in the presence of severe PH. @ERSpublications Correction of hypoventilation should be the main objective in chronic respiratory insufficiency, even with severe PH

Severe Pulmonary Hypertension Associated with COPD: Hemodynamic Improvement with Specific Therapy

“…Therefore, patients in the present study corresponded to those described by Chaouat et al [8] as having COPD with disproportionate precapillary PH, who have severe PH, and milder obstructive ventilator pattern and shorter survival as compared to those with COPD and no PH or mild PH. Patients in our series did not have chronic hypoventilation, which when present should be the main objective of management, even in the presence of severe PH [32,33]. None of the patients had endoscopic lung volume reduction, which may improve hemodynamic parameters in patients with severe emphysema and PH [34].…”

Long‐term outcome with focus on pulmonary hypertension in Obesity Hypoventilation Syndrome

“…[7][8][9] However, robust data on PH in OHS, particularly its prevalence in patients with NPPV, are scarce. [9][10][11][12][13] In a previous work, we determined PH by right heart catheterization (RHC) in a prospective cross-sectional study of clinically stable OHS patients, treated with NPPV for at least 3 months. 14 This study revealed that mild to moderate, predominately pre-capillary PH is common in OHS.…”

“…In addition to left heart failure, coronary heart disease and systemic hypertension, pulmonary hypertension (PH) is an important feature in OHS 7‐9 . However, robust data on PH in OHS, particularly its prevalence in patients with NPPV, are scarce 9‐13 …”