Translating Evidence into Clinical Practice

Pulmonary hypertension (PH) associated with lung disease and hypoxia (WHO Group III) is one of the most common forms of pulmonary hypertension. It also encompasses a very diverse group of diseases where the PH is an extremely important determinant of functional limitation and prognosis. In this group of diseases, PH is common in advanced disease, however its prevalence in milder disease is not known. None of the non-invasive screening methods have been found to be accurate and the best screening tool, Doppler echocardiography, is especially prone to error. Treating these patients can be a frustrating experience because of the lack of prospective trials and the associated underlying lung disease. Several questions remain unanswered including the populations to be screened, best diagnostic approach, and treatment options. In the current issue of Advances, all these questions have been addressed by some of the key thought-leaders in this field.

In our article on PH in Obstructive Sleep Apnea (OSA), Dr Chua and I have tried to summarize the clinically relevant literature on pulmonary hemodynamics in patients with OSA. We point out that PH in OSA is a multi-factorial process and may have important implications in terms of functional capacity and prognosis in these patients. CPAP therapy may be helpful in patients with mild PH, however more studies are needed to better define the role of PH-specific therapy in patients with more significant PH.

The articles by Dr Klinger on PH in interstitial lung diseases, Dr Girgis on PH in sarcoidosis, and Dr Preston on PH in COPD all provide an exhaustive yet focused review of the literature. These authors make several recommendations that readers can utilize in their clinical practice in terms of diagnostic evaluation and when faced with various treatment dilemmas.

The roundtable is hosted by me and discussants are Drs Nicholas Hill and Steve Nathan, who bring a wealth of experience and wisdom to the discussion. During the roundtable discussion, we addressed several clinically relevant questions that many of us are faced with everyday including the elusive questions on “disproportionate PH” and the art of choosing who to treat and with what.

I have really enjoyed planning this issue with the expert review of Dr Charles Burger and hope that all of you will come away with important information that will prove useful in caring for your patients.