Methamphetamine use and pulmonary arterial hypertension

Mar 24 2008

The Pulmonary Hypertension Association (PHA), in conjunction with leading pulmonary hypertension specialists, has announced the launch of an educational campaign to raise awareness of the association between pulmonary arterial hypertension (PAH) and stimulant use, particularly methamphetamine use.

While national and regional variances in methamphetamine use exist, one study conducted at the University of California, San Diego (UCSD), observed methamphetamine use in approximately 24 percent of patients with previously unknown risk factors for the disease. PAH is a rare, life-threatening blood vessel disorder of the lungs that causes the pressure in the pulmonary artery to rise above normal levels.

"We are seeing more and more PAH patients come into the clinic that are current or former methamphetamine users," said Richard Channick, M.D., professor of clinical medicine, Pulmonary and Critical Care Division at UCSD. "There is an urgency to get this message out to drug rehabilitation centers and physicians seeing patients with a history of substance abuse, and make sure they are aware of this association and of the symptoms of PAH. PAH is often misdiagnosed because the symptoms are similar to those seen with asthma and other respiratory conditions."

"Over the past few years, our physicians have made significant progress toward improving the lives of patients with PAH through earlier diagnosis, increased disease recognition, and continued development of effective therapies," said Rino Aldrighetti, president of the PHA. "However, we need to increase awareness among physicians, drug rehabilitation centers, and the general public about this association between methamphetamine usage and the development of PAH so that patients can receive proper treatment as early as possible."

In a retrospective study entitled, "Is Methamphetamine Use Associated With Idiopathic Pulmonary Arterial Hypertension," published in the December 2006 issue of CHEST, Dr. Kelly Chin and colleagues at UCSD studied rates of stimulant use -- any reported use of amphetamine, methamphetamine, or cocaine -- in 340 patients with either IPAH, PAH resulting from a known risk factor, or chronic thromboembolic pulmonary hypertension. A history of stimulant use was found in 29 percent of patients with a diagnosis of idiopathic PAH, compared with 4 percent of patients with PAH and a known risk factor, and 4 percent of patients with chronic thromboembolic pulmonary hypertension. After adjustment for differences in age and gender, patients with idiopathic PAH were eight to ten times more likely to have used stimulants than patients with these other forms of pulmonary hypertension.

About Pulmonary Arterial Hypertension (PAH)

PAH is a rare blood vessel disorder of the lung in which the pressure in the pulmonary artery rises above normal levels and may become life threatening. PAH is diagnosed when other more common causes of pulmonary hypertension such as severe emphysema, interstitial lung disease, heart failure and chronic pulmonary thromboembolism have been ruled out. Idiopathic pulmonary arterial hypertension (IPAH) refers to PAH that occurs without a known cause and is extremely rare. PAH can also occur in association with collagen vascular diseases such as scleroderma, CREST syndrome and systemic lupus erythematosus (SLE), congenital heart diseases, HIV infection and liver disease. Use of diet drugs like fenfluramine and dexfenfluramine can also lead to PAH, and an association between PAH and substance abuse, including methamphetamine, amphetamine, and cocaine use, has also been seen.

PAH is under-diagnosed because its early symptoms, including shortness of breath, chest pain, tiredness, lightheadedness, and fainting, are often misdiagnosed with those of many other conditions such as asthma. PAH has been historically chronic and incurable with a poor survival rate, because the disease has often progressed to a late stage by the time it is accurately diagnosed. However, new treatments are available which have significantly improved prognosis. Recent data indicate that the length of survival is continuing to improve, with some patients able to manage the disorder for 15 to 20 years or longer.

About the Pulmonary Hypertension Association and the Campaign

The Pulmonary Hypertension Association (PHA) is dedicated to finding ways to prevent and cure pulmonary hypertension, and to provide hope for the pulmonary hypertension community through support, education, advocacy and awareness. The vision of PHA is to improve the lives of those affected by pulmonary hypertension.