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PULMONARY VASCULAR DISEASE: THE GLOBAL PERSPECTIVEPulmonary Hypertension in COPD: Epidemiology, Significance, and Management: Pulmonary Vascular Disease: The Global Perspective
Section snippets
Pulmonary Hemodynamics in COPD
The literature on the prevalence of PH in COPD is confounded by several limiting factors. Estimates of the prevalence of PH in patients with COPD vary widely (Table 1) based on the definition of PH, the physiologic characteristics of the underlying lung disease, and the methods used to determine pulmonary pressures. The true prevalence of PH in patients with mild or moderate COPD is not known because of the absence of large-scale epidemiologic studies. Most studies have reported a prevalence of
Diagnosis
It is unclear whether screening for PH is feasible in patients with COPD and, if so, which population should be screened. As discussed, patients with advanced compromise in pulmonary function often have PH, but the prevalence, etiology, and significance of PH in patients with mild COPD is unclear (Table 4).
PH should be suspected in patients with COPD and declining functional capacity or increasing shortness of breath in the presence of stable airflow obstruction and the lack of an alternative
Treatment
Investigators have attempted to study the role of various treatment modalities in patients with COPD, given its frequency and profound impact on both functional capacity and survival (Table 5). The goals of treatment remain alleviation of clinical symptoms, improvement in hemodynamics and RV performance, and improved functional parameters and survival. It is important to first rule out treatable comorbid conditions, such as pulmonary embolism, left-sided cardiac disease, and obstructive sleep
Acknowledgments
Financial/nonfinancial disclosures: The authors have reported to CHEST the following conflicts of interest: Dr Minai is a member of the scientific advisory board and speakers bureau for Actelion, United Therapeutics, and Gilead and a member of the scientific advisory board for Pfizer. Drs Adnot and Chaouat have reported that no potential conflicts exist with any companies/organizations whose products or services may be discussed in this article.
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