Abstract
Background: Pulmonary hypertension (PH) is frequently underdiagnosed and under-evaluated in chronic obstructive pulmonary diseases (COPD) patients. As PH is linked to a high rate of mortality from disease-related complications like cor pulmonale, it is critical to have a unified approach to diagnosing and treating it with the aim of improving the patient's quality of life and prognosis in terms of therapeutic considerations. Early identification of this comorbidity in patients with COPD can lead to early initiation of treatment and better prognostic implications. This study was undertaken with the aim of estimating the prevalence of PH in COPD as well as assessing any statistically significant associations between the severity of PH and the severity of COPD.Methods: This was an observational study undertaken at the Department of Respiratory Medicine, Acharya Vinoba Bhave Rural Hospital (AVBRH) in Wardha, Maharastra, India, from August 2019 to September 2021. A total of 100 patients diagnosed with COPD on the basis of spirometry were evaluated with two-dimensional (2D) echocardiography to screen for echocardiographic signs and evidence of PH and severity staging of PH if present.Results: In our study, out of 100 diagnosed cases of COPD, the prevalence of PH was found to be 40% (40 patients) and amongst these, mild, moderate, and severe PH was seen in 26 patients (26%), nine patients (9%), and five patients (5%), respectively. The frequency of PH in moderate COPD was 25% and in severe COPD was 51.5%.Conclusions: PH was found in almost half the COPD patients in the study. Also, the degree and frequency of PH increased with the increase in COPD severity and this was found to be statistically significant.
Highlights
The most common comorbidities associated with chronic obstructive pulmonary disease (COPD) are systemic hypertension, ischemic heart disease, Type 2 diabetes mellitus, respiratory infections, nutritional deficiencies, Pulmonary hypertension (PH), cor pulmonale, pulmonary thromboembolism, depression, and anemia [1]
All male and female patients above 18 years of age, who were diagnosed with chronic obstructive pulmonary diseases (COPD) on the basis of spirometry post-bronchodilator forced expiratory volume in one second/forced expiratory volume (FEV1/FVC) ratio less than 0.7 as per Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines [8], and were willing to participate in the study after giving informed consent, were included in the study
As the COPD severity increased, prevalence and severity of PH were found to be increased in the study and it was observed that severe PH was present mostly in patients with severe COPD
Summary
The most common comorbidities associated with chronic obstructive pulmonary disease (COPD) are systemic hypertension, ischemic heart disease, Type 2 diabetes mellitus, respiratory infections, nutritional deficiencies, PH, cor pulmonale, pulmonary thromboembolism, depression, and anemia [1]. The “Gold Standard” for the evaluation of pulmonary vascular pressures as well as for diagnosing primary PH, and evaluation of congenital heart diseases prior to cardiac or lung surgeries and heart-lung transplantation surgery is still right heart catheterization (RHC) [7] It is not, feasible to perform RHC in every patient given the high prevalence of COPD, the high prevalence of PH in COPD, significantly associated risks due to the invasive nature of the procedure, and cost issues [6]. As PH is linked to a high rate of mortality from diseaserelated complications like cor pulmonale, it is critical to have a unified approach to diagnosing and treating it with the aim of improving the patient's quality of life and prognosis in terms of therapeutic considerations Identification of this comorbidity in patients with COPD can lead to early initiation of treatment and better prognostic implications.
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