COPD phenotyping can help manage and identify pulmonary hypertension by looking at three clinical variables, new research shows.
“All PH is prognostically relevant in COPD, but severe PH is associated with severely decreased survival, and it is frequently associated with a different phenotype of COPD, with less severe airway obstruction but more severe diffusion [capacity] and more severe hypoxemia as well,” Gabor Kovacs, MD, associate professor of pulmonology, Medical University of Graz, Graz, Austria, explained to Medscape Medical News.
“We believe that patients with this specific phenotype might benefit from individualized therapy, but we need to identify them first and we need non-invasive tools to [select out] patients with this phenotype from the large number of COPD patients without it,” he added.
The study was published online January 26 in the journal CHEST. A total of 142 patients with COPD who had undergone clinically indicated right heart catheterization for suspected PH were included in the analysis. “The diagnosis of COPD and the severity of airflow limitation were established according to the GOLD [Global Initiative for Chronic Obstructive Lung Disease] recommendations,” Kovacs and colleagues note.
Stratified for the severity of PH, 74 participants had severe PH, 45 had moderate PH, and only 23 patients had no PH, investigators observed.
COPD with severe PH was defined as a mean pulmonary arterial pressure (mPAP) ≥ 35 mm Hg or mPAP ≥ 25 mm Hg with a low cardiac index of less than 2.0 L/min/m2. COPD with moderate PH was defined as mPAP 25-34 mm Hg or mPAP of 21-24 mm Hg with pulmonary vascular resistance (PVR) ≥ 3 Wood Units (WU). COPD without PH was defined as a MPAP < 21 mm Hg or mPAP of 21-24 mm Hg with a PVR < 3 WU.