Prevalence and diagnosis of severe pulmonary hypertension in patients with chronic obstructive pulmonary disease

Purpose of review The possible development of pulmonary hypertension is a well-known complication in the course of chronic obstructive pulmonary disease. When present, pulmonary hypertension is in general of mild severity at rest. It is therefore generally considered as a second-rank marker of the disease, mainly because the patients are limited in their exercise capacity for respiratory rather than for circulatory reasons. Apart from the common hemodynamic profile, however, some patients have a moderate-to-severe level of mean pulmonary artery pressure. Recent findings These patients with a predominant vascular disease have been individualized recently. They have in common some particularities, the most characteristic profile being a mild-to-moderate airway obstruction, contrasting with the severity of dyspnea and hypoxemia. Another typical feature in these patients is the apparently poor prognosis. Summary Such patients have to be recognized because they are potential candidates for specific therapies aiming at reducing pulmonary vascular resistance.