PPP -- COPD Asthma

PPP -- COPD Asthma - PPPAsth ma COPD Pulmonary Artery...

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PPP- Asthma & COPD Pulmonary Artery Hypertension Asthma (obstruction) COPD (obstruction) Elevated PA pressure – Vascular proliferation – Remodeling of small pulmonary arteries – Progressive increase in pulmonary vascular resistance – Right heart failure and death   Interplay of pulmonary vascular smooth muscle cells and pulmonary vascular endothelium – Imbalance between mediators of vasoconstriction and vasodilation TREATMENT:    Calcium channel blockers – Nifedipine: Generally poorly effective   Prostacyclin – Intravenous epoprosenol [e.g. FLOLAN] – Iloprost [VENTAVIS], protacyclin analog, inhalation 6-9 times/day   Endothelin Receptor Antagonists – Blocks ET-1 a potent pulmonary vasoconstrictor A chronic inflammatory disease of the airways  – A chronic inflammatory disease of the respiratory tract – Mast cell activation – Eosinophil infiltration – Bronchoconstriction • Histamine • Leukotrine D4 • Prostoglandin D2 – Predominance of neutrophils, macrophages and cytotoxic T-lymphocytes – Airway hyper-responsiveness – Increased mucus secreting cells and mucus – Inflammation responsive to glucocorticoids (mostly) – Small airway narrowing and fibrosis (chronic obstructive bronchiloitis) – Destruction of alveolar walls (emphysema) – Inflammation unresponsive to glucocorticoids (mostly) – Often early disease onset (childhood)  –Often not progressive – Strongly smoking related – Progressive
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