0
Editorials |

World Health Organization Class III COPD-Associated Pulmonary Hypertension: Are We There Yet in Understanding the Pathobiology of the Disease?

M. Kathryn Steiner, MD
Author and Funding Information

Correspondence to: M. Kathryn Steiner, MD, UMass Memorial Medical Center, Medicine, 55 Lake Ave North, Worcester, MA 01655; e-mail: marciakathryn.steiner@umassmemorial.org

Dr. Steiner is Assistant Professor of Medicine, Lung, Allergy and Critical Care Medicine, University of Massachusetts Memorial Medical Center, Worcester, MA.


The author has 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/site/misc/reprints.xhtml).


© 2009 American College of Chest Physicians


Chest. 2009;136(3):658-659. doi:10.1378/chest.09-0896
Text Size: A A A
Published online

Extract

Pulmonary hypertension (PH) associated with respiratory lung diseases that create a hypoxic milieu, such as with COPD, are regarded as separate entities according to the World Health Organization (WHO) classification (WHO group III).1 For a long time, it has been postulated that hypoxia has a major impact on the pulmonary circulation, while factors such as polycythemia and hypercapnia have relatively minor roles in the development of PH.2,3 The original description by Von Euler and Liljestrand4 of the adaptation of perfusion to ventilation in lung physiology, observed that hypoxic pulmonary vasoconstriction is one of the major components to maintain adequate alveolar capillary gas exchange. In this manner, pulmonary blood flow is directed preferentially to well-ventilated areas of the lung at rest, and to alterations in these regional areas when changing from a supine to prone position or when under stress, such as with exercise. While acute hypoxic vasoconstrictive adjustments to maintain adequate perfusion and ventilation ratios are integral to a healthy, functioning lung, chronic hypoxia may lead to the development of PH.

First Page Preview

View Large
First page PDF preview

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543