Ventilatory And Cardiocirculatory Exercise Profiles In COPD: The Role Of Pulmonary Hypertension

Boerrigter, Bart; Bogaard, Harm Jan; Trip, Pia; Groepenhoff, Herman; Rietema, Heleen; Holverda, Bas; Boonstra, Anco; Postmus, Pieter E.; Westerhof, Nico; Vonk‐Noordegraaf, Anton

doi:10.1164/ajrccm-conference.2012.185.1_meetingabstracts.a6238

Cited by 49 publications

(71 citation statements)

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“…Survival analysis suggested that NT-proBNP may be a better outcome measure than 6MWD in those with lung disease where exercise capacity will be ventilatory-limited in addition to cardiovascular limitation. The negative correlation observed between FEV1 and 6MWD in those with COPD could support this ventilatory limitation [29]. Surprisingly, using the classification suggested by SEEGER et al [10], no difference in survival was suggested between those with severe PH/mild lung disease and severe PH/severe lung disease groups, with the exception of severe PH-ILD, which similarly to the overall ILD cohort showed poor survival.…”

Section: Discussionmentioning

confidence: 84%

Severe pulmonary hypertension in lung disease: phenotypes and response to treatment

et al. 2015

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Pulmonary hypertension (PH) due to lung disease (World Health Organization (WHO) group 3) is common, but severe PH, arbitrarily defined as mean pulmonary artery pressure ⩾35 mmHg is reported in only a small proportion. Whether these should be treated as patients in WHO group 1 (i.e. pulmonary arterial hypertension) with PH-targeted therapies is unknown.We compared the phenotypic characteristics and outcomes of 118 incident patients with severe PH and lung disease with 74 idiopathic pulmonary arterial hypertension (IPAH) patients, all treated with pulmonary vasodilators.Lung disease patients were older, more hypoxaemic, and had lower gas transfer, worse New York Heart Association functional class and lower 6-min walking distance (6MWD) than IPAH patients. Poorer survival in those with lung disease was driven by the interstitial lung disease (ILD) cohort.In contrast to IPAH, where significant improvements in 6MWD and N-terminal pro-brain natruiretic peptide (NT-proBNP) occurred, PH therapy in severe PH lung disease did not lead to improvement in 6MWD or functional class, but neither was deterioration seen. NT-proBNP decreased from 2200 to 1596 pg·mL −1 ( p=0.015). Response varied by lung disease phenotype, with poorer outcomes in patients with ILD and emphysema with preserved forced expiratory volume in 1 s. Further study is required to investigate whether vasodilator therapy may delay disease progression in severe PH with lung disease. @ERSpublications Treatment of severe pulmonary hypertension associated with lung disease can improve or stabilise noninvasive outcomes

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Section: Discussionmentioning

confidence: 84%

Severe pulmonary hypertension in lung disease: phenotypes and response to treatment

et al. 2015

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“…These important parameters have utility in counselling patients regarding prognosis. In addition, while in mild-moderate PH-COPD exercise capacity is limited by exhaustion of ventilatory reserve [31], mean PAP o40 mmHg has recently been shown to characterise patients with PH-COPD who have an exhausted circulatory reserve on exercise [32].…”

Section: Discussionmentioning

confidence: 99%

Pulmonary hypertension in COPD: results from the ASPIRE registry

et al. 2012

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The phenotype and outcome of severe pulmonary hypertension in chronic obstructive pulmonary disease (COPD) is described in small numbers, and predictors of survival are unknown. Data was retrieved for 101 consecutive, treatment-naïve cases of pulmonary hypertension in COPD.Mean¡SD follow-up was 2.3¡1.9 years. 59 patients with COPD and severe pulmonary hypertension, defined by catheter mean pulmonary artery pressure o40 mmHg, had significantly lower carbon monoxide diffusion, less severe airflow obstruction but not significantly different emphysema scores on computed tomography compared to 42 patients with mild-moderate pulmonary hypertension. 1-and 3-year survival for severe pulmonary hypertension, at 70% and 33%, respectively, was inferior to 83% and 55%, respectively, for mild-moderate pulmonary hypertension. Mixed venous oxygen saturation, carbon monoxide diffusion, World Health Organization functional class and age, but not severity of airflow obstruction, were independent predictors of outcome. Compassionate treatment with targeted therapies in 43 patients with severe pulmonary hypertension was not associated with a survival benefit, although improvement in functional class and/or fall in pulmonary vascular resistance .20% following treatment identified patients with improved survival.Standard prognostic markers in COPD have limited value in patients with pulmonary hypertension. This study identifies variables that predict outcome in this phenotype. Despite poor prognosis, our data suggest that further evaluation of targeted therapies is warranted.

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“…Although pulmonary hypertension in COPD is usually of moderate severity, its presence is associated with shorter survival, more frequent exacerbations and an increased use of health resources [3]. While airflow obstruction is the major factor limiting exercise tolerance in COPD, recent data suggest that the presence of pulmonary hypertension might also contribute to exercise impairment [4,5], particularly in those with severe pulmonary hypertension [6]. There is currently no pharmacological treatment for pulmonary hypertension in COPD [7].…”

Section: Introductionmentioning

confidence: 99%

Sildenafil to improve respiratory rehabilitation outcomes in COPD: a controlled trial

et al. 2013

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Pulmonary hypertension is a serious complication of chronic obstructive pulmonary disease (COPD) that currently has no established pharmacological treatment. This study aimed to assess whether concomitant treatment with sildenafil would enhance the results of pulmonary rehabilitation in patients with COPD and increased pulmonary arterial pressure (PAP).In this double-blind, randomised controlled trial patients received 20 mg sildenafil or placebo three times daily and underwent pulmonary rehabilitation for 3 months. The primary end-point was the gain in the cycle endurance time at a constant work-rate. Secondary end-points included performance in the incremental exercise test, 6-min walk distance and quality of life.63 patients with severe COPD and moderately increased PAP were randomised. Cycle endurance time increased by 149 s (95% CI 26-518 s) in the sildenafil group and by 169 s (95% CI 0-768 s) in the placebo group (median change difference -7 s, 95% CI -540-244 s; p50.77). Gains in the incremental exercise test, 6-min walk distance and quality of life at the end of the study did not differ between groups. Measurements of arterial oxygenation and adverse events were similar in both groups.In patients with severe COPD and moderately increased PAP, concomitant treatment with sildenafil does not improve the results of pulmonary rehabilitation in exercise tolerance. @ERSpublications Sildenafil did not improve respiratory rehabilitation outcomes in patients with severe COPD and moderately increased PAP

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Ventilatory And Cardiocirculatory Exercise Profiles In COPD: The Role Of Pulmonary Hypertension

Cited by 49 publications

References 0 publications

Severe pulmonary hypertension in lung disease: phenotypes and response to treatment

Severe pulmonary hypertension in lung disease: phenotypes and response to treatment

Pulmonary hypertension in COPD: results from the ASPIRE registry

Sildenafil to improve respiratory rehabilitation outcomes in COPD: a controlled trial

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