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Obstruktive Lungenerkrankungen und pulmonale Hypertonie

Obstructive pulmonary diseases and pulmonary hypertension

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Zusammenfassung

Die Entwicklung einer pulmonalen Hypertonie ist eine häufige Komplikation der chronisch obstruktiven Lungenerkrankung (COPD). Gerade bei gleichzeitigem Auftreten einer COPD und eines Schlafapnoesyndroms (sog. „Overlap-Syndrom“) ist das Risiko für eine pulmonale Hypertonie besonders hoch. Pathophysiologisch können sowohl toxische Effekte (z. B. Zigarettenrauch) als auch eine alveoläre Hypoventilation eine Endotheldysfunktion induzieren. Verstärkt durch genetische Faktoren und Zytokine/Wachstumsfaktoren wird ein Remodeling der pulmonalen Gefäße induziert, welches letztlich zur Ausbildung einer zunächst reversiblen, im weiteren Verlauf irreversiblen pulmonalen Hypertonie führt. Die Therapie besteht zurzeit noch aus der optimalen Behandlung der Grunderkrankung und einer Sauerstofflangzeittherapie. Welche Patienten von einer zusätzlichen spezifischen Therapie mit neuen Substanzen profitieren, ist Gegenstand aktueller Studien.

Abstract

Pulmonary hypertension is a frequent complication of chronic obstructive pulmonary disease. Especially in patients with concurrent sleep apnoe syndrome (so called “overlap syndrome”), the risk for pulmonary hypertension is high. Pathophysiologically, both toxic effects (cigarette smoke) and alveolar hypoventilation can induce dysfunction of the pulmonary endothelium. Genetic factors and cytokines/growth factors released by inflammatory cells may induce remodeling of the pulmonary vessels. Pulmonary hypertension results, which is initially reversible, but gradually worsens over time. At present, therapeutic options include long term oxygen in addition to the treatment of the underlying disease. A subgroup of patients may profit of a specific therapy with sildenafil and other new substances. However, studies that define these subgroups need to be performed.

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  1. Innere Medizin I (Kardiologie, Pneumologie, Internistische Intensivmedizin), Asklepios Klinik Wandsbek, Alphonsstraße 14, 22043, Hamburg, Deutschland

    C. Neumann, C. Volk, A.R. Wewel &  J. Braun

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  1. C. Neumann
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  2. C. Volk
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  3. A.R. Wewel
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  4. J. Braun
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Correspondence to J. Braun.

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Neumann, C., Volk, C., Wewel, A. et al. Obstruktive Lungenerkrankungen und pulmonale Hypertonie. Internist 50, 1064–1071 (2009). https://doi.org/10.1007/s00108-009-2337-7

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