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Piccari L, Aguilar-Colindres R, Rodríguez-Chiaradía DA. Pulmonary hypertension in interstitial lung disease and in chronic obstructive pulmonary disease: different entities? Curr Opin Pulm Med 2023:00063198-990000000-00081. [PMID: 37395513 DOI: 10.1097/mcp.0000000000000984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
PURPOSE OF REVIEW Pulmonary hypertension (PH) is a common complication of both chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD), classified as Group 3 PH. To which extent PH presents and behaves similarly in COPD and ILD is unclear. This review examines the similarities and differences in pathogenesis, clinical presentation, natural history and treatment response of PH in COPD and ILD. RECENT FINDINGS The latest studies on PH in chronic lung disease have re-evaluated the role of traditionally held etiopathogenetic factors such as tobacco exposure and hypoxia, although new ones such as airborne pollutant and genetic mutations are increasingly recognized. We examine common and diverging factors involved in PH development in COPD and ILD, as well as common and diverging clinical features of presentation, natural history and response to treatment and highlight areas for future research. SUMMARY The development of PH in lung disease significantly worsens the morbidity and mortality of patients with COPD and ILD. However, recent findings show importance of recognizing distinct patterns and behaviors of pulmonary vascular disease, taking into account the specific underlying lung disease and severity of the hemodynamic involvement. Further studies are needed to build evidence on these aspects, especially in early disease.
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Affiliation(s)
| | | | - Diego A Rodríguez-Chiaradía
- Department of Pulmonary Medicine, Hospital del Mar
- Biomedical Research Networking Centre on Respiratory Diseases (CIBERES), Madrid
- University Pompeu Fabra, Barcelona, Spain
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Arenas-De Larriva M, Martín-DeLeon R, Urrutia Royo B, Fernández-Navamuel I, Gimenez Velando A, Nuñez García L, Centeno Clemente C, Andreo García F, Rafecas Codern A, Fernández-Arias C, Pajares Ruiz V, Torrego Fernández A, Rajas O, Iturricastillo G, Garcia Lujan R, Comeche Casanova L, Sánchez-Font A, Aguilar-Colindres R, Larrosa-Barrero R, García García R, Cordovilla R, Núñez-Ares A, Briones-Gómez A, Cases Viedma E, Franco J, Cosano Povedano J, Rodríguez-Perálvarez ML, Cebrian Gallardo JJ, Nuñez Delgado M, Pavón-Masa M, Valdivia Salas MDM, Flandes J. The role of bronchoscopy in patients with SARS-CoV-2 pneumonia. ERJ Open Res 2021; 7:00165-2021. [PMID: 34258257 PMCID: PMC8183029 DOI: 10.1183/23120541.00165-2021] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 04/22/2021] [Indexed: 12/18/2022] Open
Abstract
Background The role of bronchoscopy in coronavirus disease 2019 (COVID-19) is a matter of debate. Patients and methods This observational multicentre study aimed to analyse the prognostic impact of bronchoscopic findings in a consecutive cohort of patients with suspected or confirmed COVID-19. Patients were enrolled at 17 hospitals from February to June 2020. Predictors of in-hospital mortality were assessed by multivariate logistic regression. Results A total of 1027 bronchoscopies were performed in 515 patients (age 61.5±11.2 years; 73% men), stratified into a clinical suspicion cohort (n=30) and a COVID-19 confirmed cohort (n=485). In the clinical suspicion cohort, the diagnostic yield was 36.7%. In the COVID-19 confirmed cohort, bronchoscopies were predominantly performed in the intensive care unit (n=961; 96.4%) and major indications were: difficult mechanical ventilation (43.7%), mucus plugs (39%) and persistence of radiological infiltrates (23.4%). 147 bronchoscopies were performed to rule out superinfection, and diagnostic yield was 42.9%. There were abnormalities in 91.6% of bronchoscopies, the most frequent being mucus secretions (82.4%), haematic secretions (17.7%), mucus plugs (17.6%), and diffuse mucosal hyperaemia (11.4%). The independent predictors of in-hospital mortality were: older age (OR 1.06; p<0.001), mucus plugs as indication for bronchoscopy (OR 1.60; p=0.041), absence of mucosal hyperaemia (OR 0.49; p=0.041) and the presence of haematic secretions (OR 1.79; p=0.032). Conclusion Bronchoscopy may be indicated in carefully selected patients with COVID-19 to rule out superinfection and solve complications related to mechanical ventilation. The presence of haematic secretions in the distal bronchial tract may be considered a poor prognostic feature in COVID-19. Bronchoscopy is part of the armamentarium against #COVID19. It allows diagnosis, facilitates mechanical ventilation and provides prognostic information. This information could be used to refine healthcare pathways in order to improve outcomes.https://bit.ly/2QuAQOt
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Affiliation(s)
- Marisol Arenas-De Larriva
- Dept of Bronchoscopy and Interventional Pulmonology, Hospital Universitario Reina Sofía, IMIBIC, Córdoba, Spain
| | | | - Blanca Urrutia Royo
- Pulmonary Dept, Thorax Clinic Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Iker Fernández-Navamuel
- Bronchoscopy and Interventional Pulmonology Unit, Pulmonology Dept, Hospital Fundacion Jimenez Diaz, ISS-FJD, CIBERES, Madrid, Spain
| | - Andrés Gimenez Velando
- Bronchoscopy and Interventional Pulmonology Unit, Pulmonology Dept, Hospital Fundacion Jimenez Diaz, ISS-FJD, CIBERES, Madrid, Spain
| | - Laura Nuñez García
- Bronchoscopy and Interventional Pulmonology Unit, Pulmonology Dept, Hospital Fundacion Jimenez Diaz, ISS-FJD, CIBERES, Madrid, Spain
| | - Carmen Centeno Clemente
- Interventional Pulmonology Unit, Pulmonary Dept, Thorax Clinic Institute, Hospital Universitari Germans Trias i Pujol, UAB, IGTP, Badalona, Spain
| | - Felipe Andreo García
- Interventional Pulmonology Unit, Pulmonary Dept, Thorax Clinic Institute, Hospital Universitari Germans Trias i Pujol, UAB, IGTP, Badalona, Spain
| | | | | | | | | | - Olga Rajas
- Interventional Pulmonology Unit, Pulmonology Dept, Hospital Universitario de la Princesa, Instituto de Investigación Princesa, Madrid, Spain
| | - Gorane Iturricastillo
- Pulmonology Dept, Hospital Universitario de la Princesa, Instituto de Investigación Princesa, Madrid, Spain
| | - Ricardo Garcia Lujan
- Dept of Interventional Pulmonology, Hospital Universitario 12 Octubre and Hospital Univesitario Quirónsalud Madrid, Madrid, Spain
| | | | - Albert Sánchez-Font
- Pulmonology Dept, Hospital del Mar, CIBERES, UAB, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | | | | | - Ruth García García
- Interventional Pulmonology Unit, Pulmonary Dept, Salamanca University Hospital, Salamanca, Spain
| | - Rosa Cordovilla
- Interventional Pulmonology Unit, Pulmonary Dept, Salamanca University Hospital, Salamanca, Spain
| | - Ana Núñez-Ares
- Interventional Pulmonology Unit, Pulmonary Dept, Albacete, Spain
| | - Andrés Briones-Gómez
- Interventional Pulmonology Unit, Pulmonary Dept, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Enrique Cases Viedma
- Interventional Pulmonology Unit, Pulmonary Dept, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - José Franco
- Pneumology Service, Clinic University Hospital, INCLIVA Health Research Institute, Valencia, Spain
| | - Javier Cosano Povedano
- Bronchoscopy and Interventional Pulmonology Unit, Pulmonology Dept, Hospital Universitario Reina Sofía, IMIBIC, Córdoba, Spain
| | | | | | - Manuel Nuñez Delgado
- Dept of Bronchoscopy and Interventional Pulmonology, Hospital Álvaro Cunqueiro, CHUVI, Vigo, Spain
| | - María Pavón-Masa
- Dept of Interventional Pulmonology, Hospital Universitario Virgen Macarena, Seville, Spain
| | | | - Javier Flandes
- Bronchoscopy and Interventional Pulmonology Unit, Pulmonology Dept, Hospital Fundación Jimenez Diaz, ISS-FJD, CIBERES, Madrid, Spain
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