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Der Pneumologe

, Volume 8, Issue 2, pp 113–127 | Cite as

Pulmonale Hypertonie bei chronischen Lungenerkrankungen

  • G.C. Funk
  • O.C. Burghuber
CME Weiterbildung · Zertifizierte Fortbildung
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Zusammenfassung

Die pulmonale Hypertonie ist eine Komplikation von chronischen Lungenerkrankungen und beeinflusst den Verlauf negativ. Die traditionelle pathophysiologische Vorstellung der Hypoxämie als Hauptursache für die pulmonale Hypertonie bei chronischen Lungenerkrankungen wird zunehmend durch ein Modell abgelöst, bei dem die Umbauprozesse der pulmonalen Gefäße im Vordergrund stehen. Während die Echokardiographie die entscheidende Methode zum Screening hinsichtlich pulmonaler Hypertonie bei chronischen Lungenerkrankungen darstellt, sollte die Diagnose bei entsprechender therapeutischer Konsequenz mit einem Rechtsherzkatheter gesichert werden. Bei einer neu diagnostizierten pulmonalen Hypertonie sollten zur Abklärung einer möglichen zugrunde liegenden chronischen Lungenerkrankung eine Spirometrie mit Bodyplethysmographie, eine Blutgasanalyse in Ruhe und unter Belastung und eine Computertomographie durchgeführt werden. Eine schlafbezogene Atemstörung sollte mittels einer nächtlichen Polysomnographie ausgeschlossen werden. Die Langzeitsauerstofftherapie ist eine nachweislich wirksame pharmakologische Strategie zur Behandlung der pulmonalen Hypertonie bei chronischen parenchymatösen Lungenerkrankungen. Pulmonale Vasodilatatoren können in dieser Indikation nach dem derzeitigen Wissensstand nicht empfohlen werden.

Schlüsselwörter

Pulmonale Hypertonie Chronische Lungenerkrankungen Echokardiographie Rechtsherzkatheter Langzeitsauerstofftherapie 

Pulmonary hypertension in chronic respiratory diseases

Abstract

Pulmonary hypertension is a well-known complication of chronic respiratory diseases with an adverse influence on prognosis. While hypoxaemia has been traditionally viewed as the main cause of pulmonary vasoconstriction with a subsequent increase of pulmonary arterial pressure, the importance of pulmonary vasculature remodelling is being increasingly realized. Patients with chronic lung diseases who are suspected of having pulmonary hypertension should be screened by transthoracic echocardiography. A diagnosis of pulmonary hypertension should be verified by right heart catheterization, before a specific therapy is started. Patients newly diagnosed with pulmonary hypertension should undergo spirometry, body plethysmography, arterial blood gas analysis at rest and during exercise as well as a pulmonary CT scan with regard to an underlying disease of the respiratory system. Sleep-related disorders of breathing should be excluded by polysomnography. Long-term oxygen treatment in order to maintain sufficient oxygenation is the key therapy in patients with parenchymal lung disease and pulmonary hypertension. Given the lack of evidence of a beneficial effect, pulmonary vasodilators cannot be recommended for these patients.

Keywords

Pulmonary hypertension Chronic respiratory diseases Echocardiography Right heart catheterization Long-term oxygen treatment 

Notes

Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehungen hin: Vortragshonorare von Actelion und Pfizer.

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Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  1. 1.Interne Lungenabteilung und Ludwig Boltzmann Institut für COPD und pneumologische EpidemiologieOtto Wagner SpitalWienÖsterreich

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