Skip to main content
PMC home page
Thorax logoLink to Thorax
. 2002 Jun;57(6):473–476. doi: 10.1136/thorax.57.6.473

Peripheral airway obstruction in primary pulmonary hypertension

F Meyer 1, R Ewert 1, M Hoeper 1, H Olschewski 1, J Behr 1, J Winkler 1, H Wilkens 1, C Breuer 1, W Kubler 1, M Borst 1
PMCID: PMC1746348  PMID: 12037220

Abstract

Background: As there is controversy about changes in lung function in primary pulmonary hypertension (PPH), lung mechanics were assessed with a focus on expiratory airflow in relation to pulmonary haemodynamics.

Methods: A cross sectional study was performed in 64 controls and 171 patients with PPH (117 women) of mean (SD) age 45 (13) years, pulmonary artery pressure (PAPmean) 57 (15) mm Hg, and pulmonary vascular resistance 1371 (644) dyne.s/cm5.

Results: Mean (SD) total lung capacity was similar in patients with PPH and controls (98 (12)% predicted v 102 (17)% predicted, mean difference –4 (95% confidence interval (CI) –7.89 to –0.11); residual volume (RV) was increased (118 (24)% predicted v 109 (27)% predicted, mean difference 9 (95% CI 1.86 to 16.14); and vital capacity (VC) was decreased (91 (16)% predicted v 102 (10)% predicted, mean difference –11 (95% CI 15.19 to –6.80). RV/TLC was increased (117 (27)% predicted v 97 (29)% predicted, mean difference 20 (95% CI 12.3 to 27.8)) and correlated with PAPmean (r=0.31, p<0.001). In patients with PAPmean above the median of 56 mm Hg, RV/TLC was further increased (125 (32)% predicted v 111 (22)% predicted, mean difference –14 (95% CI –22.2 to –5.8)). Expiratory flow-volume curves were reduced and curvilinear in patients with PPH.

Conclusions: Peripheral airway obstruction is common in PPH and is more pronounced in severe disease. This may contribute to symptoms. Reversibility of bronchodilation and relation to exercise capacity need further evaluation.

Full Text

The Full Text of this article is available as a PDF (134.5 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Altman D. G., Gore S. M., Gardner M. J., Pocock S. J. Statistical guidelines for contributors to medical journals. Br Med J (Clin Res Ed) 1983 May 7;286(6376):1489–1493. doi: 10.1136/bmj.286.6376.1489. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Belvisi M. G., Stretton C. D., Yacoub M., Barnes P. J. Nitric oxide is the endogenous neurotransmitter of bronchodilator nerves in humans. Eur J Pharmacol. 1992 Jan 14;210(2):221–222. doi: 10.1016/0014-2999(92)90676-u. [DOI] [PubMed] [Google Scholar]
  3. Burke C. M., Glanville A. R., Morris A. J., Rubin D., Harvey J. A., Theodore J., Robin E. D. Pulmonary function in advanced pulmonary hypertension. Thorax. 1987 Feb;42(2):131–135. doi: 10.1136/thx.42.2.131. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Dinh-Xuan A. T., Higenbottam T. W., Clelland C. A., Pepke-Zaba J., Cremona G., Butt A. Y., Large S. R., Wells F. C., Wallwork J. Impairment of endothelium-dependent pulmonary-artery relaxation in chronic obstructive lung disease. N Engl J Med. 1991 May 30;324(22):1539–1547. doi: 10.1056/NEJM199105303242203. [DOI] [PubMed] [Google Scholar]
  5. Ewert R., Opitz C., Wensel R., Winkler J., Höffken G., Frank W., Berger F., Kleber F. X., Hetzer R. Iloprost als inhalative bzw. intravenöse Langzeitbehandlung von Patienten mit Primärer Pulmonaler Hypertonie. Register der Berliner Arbeitsgruppe für Pulmonale Hypertonie. Z Kardiol. 2000 Nov;89(11):987–999. doi: 10.1007/s003920070150. [DOI] [PubMed] [Google Scholar]
  6. Fagan K. A., McMurtry I. F., Rodman D. M. Role of endothelin-1 in lung disease. Respir Res. 2001 Feb 22;2(2):90–101. doi: 10.1186/rr44. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Fernandez-Bonetti P., Lupi-Herrera E., Martinez-Guerra M. L., Barrios R., Seoane M., Sandoval J. Peripheral airways obstruction in idiopathic pulmonary artery hypertension (primary). Chest. 1983 May;83(5):732–738. doi: 10.1378/chest.83.5.732. [DOI] [PubMed] [Google Scholar]
  8. Gazetopoulos N., Salonikides N., Davies H. Cardiopulmonary function in patients with pulmonary hypertension. Br Heart J. 1974 Jan;36(1):19–28. doi: 10.1136/hrt.36.1.19. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Giaid A., Saleh D. Reduced expression of endothelial nitric oxide synthase in the lungs of patients with pulmonary hypertension. N Engl J Med. 1995 Jul 27;333(4):214–221. doi: 10.1056/NEJM199507273330403. [DOI] [PubMed] [Google Scholar]
  10. Hoeper M. M., Maier R., Tongers J., Niedermeyer J., Hohlfeld J. M., Hamm M., Fabel H. Determination of cardiac output by the Fick method, thermodilution, and acetylene rebreathing in pulmonary hypertension. Am J Respir Crit Care Med. 1999 Aug;160(2):535–541. doi: 10.1164/ajrccm.160.2.9811062. [DOI] [PubMed] [Google Scholar]
  11. Hoeper M. M., Olschewski H., Ghofrani H. A., Wilkens H., Winkler J., Borst M. M., Niedermeyer J., Fabel H., Seeger W. A comparison of the acute hemodynamic effects of inhaled nitric oxide and aerosolized iloprost in primary pulmonary hypertension. German PPH study group. J Am Coll Cardiol. 2000 Jan;35(1):176–182. doi: 10.1016/s0735-1097(99)00494-5. [DOI] [PubMed] [Google Scholar]
  12. Horn M., Ries A., Neveu C., Moser K. Restrictive ventilatory pattern in precapillary pulmonary hypertension. Am Rev Respir Dis. 1983 Jul;128(1):163–165. doi: 10.1164/arrd.1983.128.1.163. [DOI] [PubMed] [Google Scholar]
  13. Inscore S. C., Stenmark K. R., Orton C., Irvin C. G. Neonatal calves develop airflow limitation due to chronic hypobaric hypoxia. J Appl Physiol (1985) 1991 Jan;70(1):384–390. doi: 10.1152/jappl.1991.70.1.384. [DOI] [PubMed] [Google Scholar]
  14. Kindman L. A., Vagelos R. H., Willson K., Prikazky L., Fowler M. Abnormalities of pulmonary function in patients with congestive heart failure, and reversal with ipratropium bromide. Am J Cardiol. 1994 Feb 1;73(4):258–262. doi: 10.1016/0002-9149(94)90230-5. [DOI] [PubMed] [Google Scholar]
  15. Lai Y. L., Olson J. W., Gillespie M. N. Ventilatory dysfunction precedes pulmonary vascular changes in monocrotaline-treated rats. J Appl Physiol (1985) 1991 Feb;70(2):561–566. doi: 10.1152/jappl.1991.70.2.561. [DOI] [PubMed] [Google Scholar]
  16. Meyer F. J., Borst M. M., Zugck C., Kirschke A., Schellberg D., Kübler W., Haass M. Respiratory muscle dysfunction in congestive heart failure: clinical correlation and prognostic significance. Circulation. 2001 May 1;103(17):2153–2158. doi: 10.1161/01.cir.103.17.2153. [DOI] [PubMed] [Google Scholar]
  17. Meyer F. J., Zugck C., Haass M., Otterspoor L., Strasser R. H., Kübler W., Borst M. M. Inefficient ventilation and reduced respiratory muscle capacity in congestive heart failure. Basic Res Cardiol. 2000 Aug;95(4):333–342. doi: 10.1007/s003950070053. [DOI] [PubMed] [Google Scholar]
  18. O'Hagan A. R., Stillwell P. C., Arroliga A. Airway responsiveness to inhaled albuterol in patients with pulmonary hypertension. Clin Pediatr (Phila) 1999 Jan;38(1):27–33. doi: 10.1177/000992289903800104. [DOI] [PubMed] [Google Scholar]
  19. Olschewski H., Ghofrani H. A., Schmehl T., Winkler J., Wilkens H., Höper M. M., Behr J., Kleber F. X., Seeger W. Inhaled iloprost to treat severe pulmonary hypertension. An uncontrolled trial. German PPH Study Group. Ann Intern Med. 2000 Mar 21;132(6):435–443. doi: 10.7326/0003-4819-132-6-200003210-00003. [DOI] [PubMed] [Google Scholar]
  20. Peacock A. J. Primary pulmonary hypertension. Thorax. 1999 Dec;54(12):1107–1118. doi: 10.1136/thx.54.12.1107. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Pride N. B., Permutt S., Riley R. L., Bromberger-Barnea B. Determinants of maximal expiratory flow from the lungs. J Appl Physiol. 1967 Nov;23(5):646–662. doi: 10.1152/jappl.1967.23.5.646. [DOI] [PubMed] [Google Scholar]
  22. Rich S., Dantzker D. R., Ayres S. M., Bergofsky E. H., Brundage B. H., Detre K. M., Fishman A. P., Goldring R. M., Groves B. M., Koerner S. K. Primary pulmonary hypertension. A national prospective study. Ann Intern Med. 1987 Aug;107(2):216–223. doi: 10.7326/0003-4819-107-2-216. [DOI] [PubMed] [Google Scholar]
  23. Scharf S. M., Feldman N. T., Graboys T. B., Wellman J. J. Restrictive ventilatory defect in a patient with primary pulmonary hypertension. Am Rev Respir Dis. 1978 Aug;118(2):409–413. doi: 10.1164/arrd.1978.118.2.409. [DOI] [PubMed] [Google Scholar]
  24. Uren N. G., Davies S. W., Jordan S. L., Lipkin D. P. Inhaled bronchodilators increase maximum oxygen consumption in chronic left ventricular failure. Eur Heart J. 1993 Jun;14(6):744–750. doi: 10.1093/eurheartj/14.6.744. [DOI] [PubMed] [Google Scholar]
  25. WESSEL H. U., KEZDI P., CUGELL D. W. RESPIRATORY AND CARDIOVASCULAR FUNCTION IN PATIENTS WITH SEVERE PULMONARY HYPERTENSION. Circulation. 1964 Jun;29:825–832. doi: 10.1161/01.cir.29.6.825. [DOI] [PubMed] [Google Scholar]
  26. Williams M. H., Jr, Adler J. J., Colp C. Pulmonary function studies as an aid in the differential diagnosis of pulmonary hypertension. Am J Med. 1969 Sep;47(3):378–383. doi: 10.1016/0002-9343(69)90221-6. [DOI] [PubMed] [Google Scholar]

Articles from Thorax are provided here courtesy of BMJ Publishing Group

RESOURCES