Platypnea induced by worsening of VA/Q inhomogeneity in the sitting position in chronic obstructive lung disease.

We report a patient with COPD who experienced severe dyspnea with a decreased PaO2 in the sitting position, largely improved in the ventral prone position (platypnea). By using an isotopic method, we showed that this phenomenon is the result of a deleterious effect of the sitting position on regional ventilation/perfusion matching. We speculated that hypoxic vascular pulmonary constriction was deficient in our patient. This hypothesis is supported by a dramatically better matching of the VA/Q ratio after treatment with almitrine bismesilate, a drug that could potentiate hypoxic pulmonary vasoconstrictive reflexes.