Pulmonary hypertension (PH) is a lung disease characterized by high blood pressure in the pulmonary arteries. PH causes the pulmonary arteries, which are responsible for carrying blood from the heart to the lungs, to become narrowed and blocked. The disease often affects the right side of the heart since the right ventricle is responsible for pumping blood to the lungs – unlike the left heart ventricle that pumps blood to the rest of the body. In PH, because the heart needs to work harder to pump blood through the right ventricle, it becomes enlarged and weakened.
Shortness of breath (dyspnea), fatigue, dizziness or fainting spells (syncope), pressure or pain in the chest, swelling (edema) in the ankles, legs and abdomen (ascites), a bluish color in the lips and skin (cyanosis) and irregular heart beat are common symptoms of the disease, all of which can result in right heart failure and death. There is no cure for pulmonary hypertension and suffering from another disease, such as chronic obstructive pulmonary disease (COPD), can exacerbate it.
Development of COPD with Pulmonary Hypertension
Pulmonary hypertension is often a result of COPD and is associated with increased risks of exacerbation and decreased survival, according to the study, “Pulmonary hypertension in COPD,” published in 2008. PH as a consequence of COPD can be mild-to-moderate but the combination of the two disorders can lead to a discouraging prognosis for patients. The symptoms worsen during exercise, sleep and exacerbation.
In patients with COPD, pulmonary artery pressure increases due to pulmonary vascular remodeling, which is caused by the combinations of hypoxia, inflammation, and loss of capillaries in severe emphysema. The same 2008 study revealed that a small proportion of COPD patients may present with “out-of-proportion” pulmonary hypertension, which is defined by a mean pulmonary artery pressure of about 35-40 mmHg, with normal levels lower than 20 mmHg, and a relatively preserved lung function. The prevalence of out-of-proportion pulmonary hypertension in COPD is similar to the prevalence of idiopathic pulmonary arterial hypertension.
Difficulties in Diagnosing and Treating COPD with Pulmonary Hypertension
Diagnosis of pulmonary hypertension in patients with COPD is difficult because patients diagnosed with COPD, and are stable, do not routinely undergo right heart catheterization – which makes PH more difficult to detect. In addition, the symptoms of both diseases are easily mistaken as the another. While it is difficult to determine the prevalence of COPD with pulmonary hypertension, early detection can improve treatment and quality of life. Despite the inability to be fully understood, researchers believe that COPD with pulmonary hypertension is a common combination.
In patients with mean pulmonary artery pressure (mPAP) greater than 25 mm Hg, consistent with PH, the five-year survival rate is only 36% compared to 62% in those with initial mPAP less than or equal to 25 mm Hg, according to the study “Pulmonary Hypertension Secondary to COPD.”
Patients face a higher risk of right heart failure, with systemic congestion and inability to adapt right ventricular output to peripheral demand at exercise, ankle edema, renal problems and other complications. Some treatments can help manage symptoms. One treatment is inhaled nitric oxide, which in combination with supplemental oxygen might be effective to restore the endothelial vasoconstrictor–dilator imbalance.
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