ORIGINAL ARTICLE

Peripheral airway obstruction in primary pulmonary hypertension

F J Meyer¹, R Ewert², M M Hoeper³, H Olschewski⁴, J Behr⁵, J Winkler⁶, H Wilkens⁷, C Breuer⁸, W Kübler¹, M M Borst¹ For The German Pph Study Group

¹ Department of Internal Medicine III, Ruprecht-Karls-University, Heidelberg
² Department of Cardiothoracic Surgery, German Heart Centre, Berlin
³ Department of Pulmonary Medicine, Hanover Medical School, Hanover
⁴ Department of Internal Medicine II, Justus Liebig University, Giessen
⁵ Department of Internal Medicine I, University Hospital Grosshadern, Munich
⁶ Department of Internal Medicine, University Leipzig
⁷ Department of Pulmonary Medicine, University of the Saarland, Homburg
⁸ Department of Internal Medicine, University Hospital of the RWTH, Aachen

Correspondence to:
Correspondence to:
Dr med F J Meyer, Medizinische Universitätsklinik, Abteilung Kardiologie, Angiologie, Pneumologie, Bergheimer Strasse 58, D-69115 Heidelberg, Germany;
Joachim_Meyer{at}med.uni-heidelberg.de

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.

Keywords: pulmonary hypertension; airway obstruction; lung mechanics

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