Functional Classes

Class I

You have no symptoms during ordinary physical activity.

Class III

You usually have no symptoms at rest, but breathlessness, chest pain, fatigue or dizziness greatly limits routine activity.

Considering Comorbidities

The guidelines also introduce the concept of considering comorbidities in the treatment algorithm. Comorbidities are a person’s other health conditions or diseases.

“This has driven a lot of debate,” Humbert said. Comorbidities that the guidelines ask providers to consider, especially among elderly patients, are risk factors of left heart disease (obesity, diabetes, high blood pressure and coronary heart disease) and risk factors of lung disease (significant smoking history with alterations of the lung function). The guidelines suggest that these patients be treated with more caution because of their other conditions, starting first with monotherapy, or just one medication. This can be followed by adding in other medications.

Comorbidities such as obesity have much higher rates in the U.S. than in Europe. In the U.S., 42% of adults

Class II

You are comfortable at rest, but your ordinary physical activity is somewhat limited because of breathlessness, chest pain, fatigue or dizziness.

Class

Iv

You are often breathless and tired even while resting. You can’t do any physical activity without symptoms. You show signs of right heart failure. Anyone prone to fainting would be in this class.

are considered obese, according to the Centers for Disease Control and Prevention. About 23% of adults in Europe are obese, according to the World Health Organization, although that number has been climbing.

“It may not be appropriate to treat obese PAH patients with monotherapy,” Hemnes said.

The guidelines have been endorsed by the International Society for Heart and Lung Transplantation and the European Reference Network on rare respiratory diseases. The guidelines likely will be part of the discussion at the 7th World Symposium on Pulmonary Hypertension, Hemnes said. The event will take place in June 2024 in Barcelona, Spain.

The 2024 symposium will include pulmonary vascular disease experts from all over the world, including Humbert. Hemnes anticipates some revisions to the European guidelines as new literature is published before