ABSTRACT
Pulmonary hypertension (PH) complicating chronic respiratory disease is defined as
a mean pulmonary artery pressure (MPAP) greater than 20 mmHg at rest. Due to its
prevalence, chronic obstructive pulmonary disease (COPD) is by far the commonest
cause of PH and of cor pulmonale. In 1956 DW Richards in his Nobel lecture pointed
out that, “a considerable proportion of patients suffering from chronic pulmonary
disease with progressive pulmonary insufficiency will eventually develop cor
pulmonale.” He observed that the principal factors inducing right ventricular strain,
hypertrophy, and failure were: (1) PH, from one cause or another; and (2) secondary
influences throwing a burden on the right heart, such as anoxia, hypercapnoea,
increased blood volume, polycythaemia, increased cardiac output, and disordered
breathing mechanics (1). Our understanding of the vascular remodeling process
continues to advance, though our clinical understanding of the contribution of PH to
exercise limitation in patients with COPD remains poor. In this chapter we have
focused on the process of pulmonary vascular remodeling in patients with COPD, its
pathophysiology, and potential therapy.
