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Recent advances in the management of pulmonary hypertension with interstitial lung disease

Aaron B. Waxman, Davide Elia, Yochai Adir, Marc Humbert, Sergio Harari
European Respiratory Review 2022 31: 210220; DOI: 10.1183/16000617.0220-2021
Aaron B. Waxman
1Center for Pulmonary Heart Disease, Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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  • For correspondence: abwaxman@bwh.harvard.edu
Davide Elia
2Unità di Pneumologia e Terapia Semi-Intensiva Respiratoria, Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare, MultiMedica IRCCS, Milan, Italy
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Yochai Adir
3Pulmonology Division, Lady Davis-Carmel Medical Center, Haifa, Israel
4Bruce and Ruth Rappaport Faculty of Medicine, The Technion, Haifa, Israel
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Marc Humbert
5Université Paris-Saclay, INSERM UMR_S 999, Assistance Publique Hôpitaux de Paris, Department of Respiratory and Intensive Care Medicine, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
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Sergio Harari
2Unità di Pneumologia e Terapia Semi-Intensiva Respiratoria, Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare, MultiMedica IRCCS, Milan, Italy
6Dept of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
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Figures

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  • FIGURE 1
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    FIGURE 1

    World Symposium on Pulmonary Hypertension classification of pulmonary hypertension. mPAP: mean pulmonary artery pressure; PVR: pulmonary vascular resistance.

  • FIGURE 2
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    FIGURE 2

    Algorithm for diagnosis of pulmonary hypertension. SoB: shortness of breath; ECG: electrocardiogram; NT-proBNP: N-terminal pro-brain natriuretic peptide; DLCO: diffusing capacity of the lung for carbon monoxide; FVC: forced vital capacity; KCO: transfer coefficient of the lung for carbon monoxide; 6MWT: 6-min walk test; CT: computed tomography; PA: pulmonary artery; CPET: cardiopulmonary exercise testing; V′/Q′: ventilation/perfusion ratio; PA–aO2: alveolar–arterial oxygen tension difference; VD: dead space volume; VT: tidal volume; PaETCO2: end-tidal arterial carbon dioxide tension; V′E: minute ventilation; V′CO2: carbon dioxide production; O2: oxygen; TRV: tricuspid regurgitant velocity; RA: right atrium; RV: right ventricle; TAPSE: tricuspid annular plane systolic excursion; S′: systolic velocity.

Tables

  • Figures
  • TABLE 1

    Randomised controlled trials (RCTs) of pulmonary vasodilators in pulmonary hypertension (PH)-associated interstitial lung diseases (ILDs)

    First author [reference]YearName of RCTStudy populationDrugDurationPrimary end-pointPrimary end-point reached
    King [76]2008BUILD-1IPFBosentan12 monthsChange in 6MWDN
    Seibold [77]2010BUILD-2SScBosentan12 monthsChange in 6MWDN
    Zisman [78]2010STEP-IPFIPFSildenafil12 weeksChange in 6MWDN
    King [79]2011BUILD-3IPFBosentan57 monthsCombined#N
    Raghu [80]2013MUSICIPFMacitentan12 monthsChange in FVCN
    Raghu [81]2013ARTEMIS-IPFIPFAmbrisentan12 monthsCombined¶,+N
    Corte [82]2014IPF/NSIPBosentan16 weeksChange in PVRIN
    Kolb [83]2018INSTAGEIPFSildenafil12 weeksChange in SGRQN
    Nathan [84]2019RISE-IIPIIPRiociguat12 monthsChange in 6MWD+N
    Nathan [85]2020PF-ILDInhaled NO8 weeksChange in MVPA§Y
    Behr [86]2021SP-IPFIPFSildenafil12 monthsCombinedƒN
    Waxman [87]2021INCREASEIIPInhaled treprostinil16 weeksChange in 6MWDY

    IPF: idiopathic pulmonary fibrosis; 6MWD: 6-min walk distance; N: no; SSc: systemic sclerosis; FVC: forced vital capacity; NSIP: nonspecific idiopathic pneumonia; PVRI: pulmonary vascular resistance index; SGRQ: St George's Respiratory Questionnaire; IIP: idiopathic interstitial pneumonia; PF: pulmonary fibrosis; NO: nitric oxide; Y: yes; MVPA: moderate/vigorous physical activity. #: a decrease of FVC from baseline in FVC ≥10% and diffusing capacity of the lung for carbon monoxide (DLCO) ≥15% or acute exacerbation of idiopathic pulmonary fibrosis or death. ¶: the first occurrence of either a decrease of ≥10% in FVC and a decrease of ≥5% in DLCO or a decrease of ≥5% in FVC and a decrease of ≥15% in DLCO; respiratory hospitalisation (hospitalisation involving worsening of, or deterioration in respiratory symptoms, gas exchange/hypoxaemia or radiographic findings on chest radiograph or high-resolution computed tomography scan; all-cause mortality. +: study terminated early because of increased severe side-effects and mortality in the treated arm. §: MVPA measured via actigraphy through a wrist-worn medical-grade physical activity monitoring device. ƒ: disease progression, defined as either a relevant decline in 6MWD, respiratory-related admission to hospital or all-cause mortality.

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    Vol 31 Issue 165 Table of Contents
    European Respiratory Review: 31 (165)
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    Recent advances in the management of pulmonary hypertension with interstitial lung disease
    Aaron B. Waxman, Davide Elia, Yochai Adir, Marc Humbert, Sergio Harari
    European Respiratory Review Sep 2022, 31 (165) 210220; DOI: 10.1183/16000617.0220-2021

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    Recent advances in the management of pulmonary hypertension with interstitial lung disease
    Aaron B. Waxman, Davide Elia, Yochai Adir, Marc Humbert, Sergio Harari
    European Respiratory Review Sep 2022, 31 (165) 210220; DOI: 10.1183/16000617.0220-2021
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    • Article
      • Abstract
      • Abstract
      • Introduction
      • Aetiology and classification
      • Haemodynamic classification
      • Screening and diagnostic evaluation
      • The role of pulmonary function testing
      • The role of echocardiography
      • The role of chest computed tomography
      • The role of exercise testing
      • Haemodynamic assessment
      • Prognosis in PH-ILD
      • Pharmacological management of PH-ILD
      • Pulmonary rehabilitation
      • Conclusion
      • Footnotes
      • References
    • Figures & Data
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    • PDF

    Subjects

    • Interstitial and orphan lung disease
    • Pulmonary vascular disease
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