Pulmonale Hypertonie bei chronischen Lungenerkrankungen

Zusammenfassung

Die 2009 veröffentlichen Europäischen Leitlinien zur Diagnostik und Therapie der Pulmonalen Hypertonie befassen sich nicht nur mit der pulmonal arteriellen Hypertonie (PAH), sondern auch mit der pulmonalen Hypertonie (PH) bei chronischen Lungenerkrankungen. Unter anderem weisen diese Leitlinien darauf hin, dass Medikamente, die derzeit für die PAH eingesetzt werden (Prostanoide, Endothelin-Rezeptor-Antagonisten und Phosphodiesterase-5 Inhibitoren) bei anderen Formen der PH bislang unzureichend untersucht sind. Daher wird der Einsatz dieser Medikamente bei Patienten mit chronischen Lungenerkrankungen und PH nicht empfohlen. Diese Empfehlung steht allerdings in einigen Fällen dem ärztlichen und ethischen Anspruch entgegen, auch andere Formen des Lungenhochdrucks zu behandeln, die die Lebensqualität und die Lebenserwartung der Betroffenen in vergleichbarer Weise einschränken.

Im Juni 2010 fand in Köln eine Konsensuskonferenz statt, die von den Deutschen Gesellschaften für Kardiologie, Pneumologie und Pädiatrische Kardiologie (DGK, DGP und DGPK) organisiert wurde, und die sich mit strittigen Themen in der praktischen Umsetzung der Europäischen Leitlinien in Deutschland befasste. Dazu wurden verschiedene Arbeitsgruppen eingesetzt, von denen eine sich gezielt der Diagnostik und Therapie der PH bei chronischen Lungenerkrankungen widmete. Die Ergebnisse und Beschlüsse dieser Arbeitsgruppe werden in dem vorliegenden Manuskript detailliert beschrieben.

Abstract

The 2009 European Guidelines on Pulmonary Hypertension did not cover only pulmonary arterial hypertension (PAH) but also some aspects of pulmonary hypertension (PH) in chronic lung disease. The European Guidelines point out that the drugs currently used to treat patients with PAH (prostanoids, endothelin receptor antagonists and phosphodiesterase-5 inhibitors) have not been sufficiently investigated in other forms of PH. Therefore, the European Guidelines do not recommend the use of these drugs in patients with chronic lung disease and PH. This recommendation, however, is not always in agreement with medical ethics as physicians feel sometimes inclined to treat other form of pulmonary hypertension which may affect quality of life and survival of these patients in a similar manner.

In June 2010, a group of German experts met in Cologne, Germany, to discuss open and controversial issues surrounding the practical implementation of the European Guidelines. The conference was sponsored by the German Society of Cardiology, the German Society of Respiratory Medicine and the German Society of Pediatric Cardiology. One of the working groups was dedicated to the diagnosis and treatment of PH in patients with chronic lung disease. The recommendations of this working group are summarized in the present paper.

pulmonale Hypertonie - COPD - Emphysem - Lungenfibrose

pulmonary hypertension - COPD - emphysema - pulmonary fibrosis

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