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Unformatted text preview: 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 &#2; Interplay of pulmonary vascular smooth muscle cells and pulmonary vascular endothelium Imbalance between mediators of vasoconstriction and vasodilation TREATMENT: &#2; Calcium channel blockers Nifedipine: Generally poorly effective &#2; Prostacyclin Intravenous epoprosenol [e.g. FLOLAN] Iloprost [VENTAVIS], protacyclin analog, inhalation 6-9 times/day &#2; 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 Bosentan [TRACLEER]...
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- Spring '11