Pulmonary hypertension in interstitial lung disease: screening, diagnosis and treatment

Purpose of review Pulmonary vascular disease resulting in pulmonary hypertension in the context of interstitial lung disease (PH-ILD) is a common complication that presents many challenges in clinical practice. Despite recent advances, the pathogenetic interplay between parenchymal and vascular disease in ILD is not fully understood. This review provides an overview of the current knowledge and recent advances in the field. Recent findings Clinical trials employing the phosphodiesterase-5-inhibitor sildenafil delivered negative results whereas riociguat showed harmful effects in the PH-ILD population. More recently, inhaled treprostinil showed positive effects on the primary endpoint (six-min walk-distance) in the largest prospective randomized placebo-controlled trial to date in this patient population. Additionally, a pilot trial of ambulatory inhaled nitric oxide suggests beneficial effects based on the novel endpoint of actigraphy. In view of these novel developments this review provides an overview of the status quo of screening, diagnosis and management of pulmonary vascular disease and PH in patients with ILD.

Automated summary

The review discusses the challenges and recent advances in understanding the pathogenesis of pulmonary hypertension in the context of interstitial lung disease (PH-ILD). Recent findings from clinical trials on different drugs and treatments for PH-ILD are highlighted, providing an overview of the current status of screening, diagnosis, and management of pulmonary vascular disease in ILD patients.