Is The Burden Of Pulmonary Hypertension In India Increasing Due To COPD?

Pulmonary Hypertension (PH) is a complex and progressive condition marked by elevated blood pressure in the pulmonary arteries. While Chronic Obstructive Pulmonary Disease (COPD) is a recognised cause of PH, it is typically associated with mild forms of the condition and is not the primary driver of the increasing burden of PH in India. The country's unique health profile and environmental factors have contributed to the high prevalence of PH due to a variety of other causes.

1. Congenital Heart Disease (CHD)

In India, untreated congenital heart defects are one of the most significant contributors to PH. Conditions like atrial septal defects or patent ductus arteriosus can lead to chronic overload of the pulmonary circulation, eventually progressing to PH. Despite advances in pediatric cardiology, delayed diagnosis and limited access to timely surgical intervention exacerbate this issue.

2. Infections

Certain infections endemic to India, such as tuberculosis, can lead to chronic inflammation and scarring of lung tissue, impairing the pulmonary vasculature. Furthermore, repeated respiratory infections and untreated cases of pulmonary tuberculosis often go undiagnosed until significant damage has occurred, resulting in a higher incidence of PH.

3. Rheumatic Heart Disease (RHD)

RHD remains a major public health challenge in India. It results from untreated or inadequately treated streptococcal infections, leading to valve damage and subsequent pulmonary hypertension. The condition is particularly prevalent in rural and underserved regions, where healthcare access is limited.

4. Hemoglobinopathies

Genetic conditions such as thalassemia and sickle cell anaemia are prevalent in India, especially in certain ethnic and geographical populations. These conditions can cause chronic hemolysis and hypoxia, contributing to the development of PH. With insufficient screening and management programs, the burden of PH linked to hemoglobinopathies remains substantial.

5. Idiopathic and Heritable Pulmonary Arterial Hypertension (PAH)

Idiopathic PAH, a rare and severe form of pulmonary hypertension with no identifiable cause, also contributes to the overall burden of PH in India. Similarly, heritable PAH, linked to genetic mutations such as BMPR2, often goes undiagnosed due to limited awareness and genetic testing facilities. Both conditions require specialised management, and early detection is crucial to improving patient outcomes.

6. Increased Awareness and Diagnosis

The rise in PH prevalence can also be attributed to better awareness and diagnostic capabilities. Improvements in medical technology and physician training have allowed for earlier detection of PH, even in cases where symptoms are subtle. While this has improved patient outcomes, it also highlights the substantial latent burden of the disease in the population.

Although COPD is a known cause of PH, it contributes primarily to mild cases and is not the key factor driving the increasing prevalence of PH in India. Addressing untreated congenital heart diseases, infections, and rheumatic heart disease, along with improved management of hemoglobinopathies and rare forms like idiopathic and heritable PAH, is critical to mitigating the burden of PH in the country. Enhanced public health interventions and access to care are pivotal in combating this growing challenge.

Dr. Prashant Bobhate

Guest Author Pediatric cardiologist and pulmonary hypertension specialist.