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Pulmonary Vascular Involvement in COPD

Víctor I. Peinado, PhD; Sandra Pizarro, MD; Joan Albert Barberà, MD
Author and Funding Information

*From the Department of Pulmonary Medicine, Hospital Clínic, Universitat de Barcelona; Institut d' Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); and Ciber de Enfermedades Respiratorias, Barcelona, Spain.

Correspondence to: Joan Albert Barberà, MD, Servei de Pneumologia, Hospital Clínic, Villarroel 170, 08036 Barcelona, Spain; e-mail: jbarbera@clinic.ub.es


The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).


Chest. 2008;134(4):808-814. doi:10.1378/chest.08-0820
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Alterations in pulmonary vessel structure and function are highly prevalent in patients with COPD. Vascular abnormalities impair gas exchange and may result in pulmonary hypertension, which is one of the principal factors associated with reduced survival in COPD patients. Changes in pulmonary circulation have been identified at initial disease stages, providing new insight into their pathogenesis. Endothelial cell damage and dysfunction produced by the effects of cigarette smoke products or inflammatory elements is now considered to be the primary alteration that initiates the sequence of events resulting in pulmonary hypertension. Cellular and molecular mechanisms involved in this process are being extensively investigated. Progress in the understanding of the pathobiology of pulmonary hypertension associated with COPD may provide the basis for a new therapeutic approach addressed to correct the imbalance between endothelium-derived vasoactive agents. The safety and efficacy of endothelium-targeted therapy in COPD-associated pulmonary hypertension warrants further investigation in randomized clinical trials.

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