Smoking: Is it a Risk Factor for Pulmonary Vascular Diseases?

Chronic obstructive pulmonary disease (COPD) summarizes chronic bronchitis and lung emphysema. A major trigger for this disease is cigarette smoking. However, the occurrence and role of pulmonary vascular remodeling and pulmonary hypertension (PH) in COPD is not clarified yet. Although PH and lung vascular remodeling were thought to be infrequent events in COPD, recent clinical data estimate that 30-70% of patients with COPD also have PH. In 50% of COPD patients evaluated for lung transplantation, mean pulmonary arterial pressure was above 25 mmHg. In addition, a much larger portion of COPD patients may be affected by morphological changes of the lung vessels and/or borderline PH. In this regard it has recently been stated that “moderate-to-severe PH is not a rare event” in COPD and “numerous studies have shown that the presence of even mild PH is of prognostic relevance in patients with COPD.”