MEDICAL-TREATMENT OF PULMONARY-HYPERTENSION IN CHRONIC LUNG-DISEASE

In chronic respiratory diseases, especially chronic obstructive pulmon ary disease (COPD) pulmonary arterial hypertension is generally mad to moderate, and the necessity for treating it can, therefore, be questi oned. In fact, pulmonary hypertension, even when modest, may worsen ma rkedly during acute episodes, exercise and sleep. These acute increase s in mean pulmonary artery pressure (PAP) could contribute to the deve lopment of right heart failure. Therefore, the medical treatment of pu lmonary hypertension is justified. There are, at the present time, no selective pulmonary vasodilators, with the exception of inhaled nitric oxide. Indeed, vasodilators appear less effective in COPD compared to primary pulmonary hypertension. Thus, there is, at present, no justif ication for the long-term use of vasodilators in COPD patients. Long-t erm oxygen therapy (LTOT) attenuates and sometimes reverses the progre ssion of pulmonary hypertension, although the condition rarely returns to normal We do not know whether the structural changes of the pulmon ary vasculature in COPD patients are potentially reversible with LTOT. The longer the daily duration of LTOT the better are the haemodynamic results. At present, LTOT remains the best treatment for pulmonary hy pertension in COPD patient. In the future, treatment of this condition in COPD patients could combine LTOT and specific vasodilators.