Changes in pulmonary circulation of patients with chronic obstructive pulmonary disease and idiopathic pulmonary fibrosis complicated by chronic respiratory failure

The aim of this study was to describe particularities of pulmonary circulation in patients with obstructive (chronic obstructive pulmonary disease (COPD)) or restrictive (idiopathic pulmonary fibrosis (IPF)) diseases and to study tendencies of pulmonary blood flow disorders in different pathological mechanisms of chronic respiratory failure (CRF).

Methods. Results of image examination (multislice computed tomography, computed angiography, singlephoton emission computed tomography) were analyzed in 150 patients with severe stage 3–4 COPD (phenotype of emphyse ma) complicated by CRF or right heart failure and in 45 patients with IPF and lung «honeycombing».

Results. Significant pulmonary circulation disorders were seen in patients with both obstructive and interstitial diseases complicated by CRF. These changes were caused by parenchyma remodeling, concomitant vascular lesions (pulmonary embolism, thrombosis in situ), cancer and persistent infectious inflammation.

Conclusions. Timely detection of changes in pulmonary parenchyma and vessels allows adequate treatment, slowing progression of the disease and improving outcomes. In patients with mild to moderate COPD, therapeutic interventions could improve the reduced blood flow in ischemic areas of the lungs significantly more often than in IPF patients. Early treatment could prevent irreversible change in ischemic lung parenchyma which usually results in CRF development. Virtually, treatment has no effect on pulmonary circulation both in patients with obstructive and restrictive diseases with irreversible changes in pulmonary vessels.

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