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#1 JJ-Knitter

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Posted 19 January 2007 - 01:32 PM

I keep hearing about WHO classes, as in WHO Class III/IV patients are suitable candidates for certain type of treatments. I've seen this especially with reference to pulmonary hypertension. What are the various classes and does anyone know where I can find out more about them? Thanks, as always.

JJ-Knitter

#2 Shelley Ensz

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Posted 19 January 2007 - 01:52 PM

Hi JJ Knitter,

We can all certainly try to answer that question here, but I thought you'd love to know that we have a great and thorough article about this in Voices of Scleroderma Volume 2 - by Professor Carol Black of Royal Free Hospital in the U.K. She is simply one of the very "tops" as far as scleroderma experts go, and it is a long article about pulmonary hypertension, and its diagnosis and treatment.

Just go to ISN Secure Donations and Purchases, and select the Volume 2 book. You can purchase it by mail (check or money order) or by credit card or PayPal.


Warm Hugs,

Shelley Ensz
Founder and President
International Scleroderma Network (ISN)
Hotline and Donations: 1-800-564-7099

The most important thing in the world to know about scleroderma is sclero.org.

#3 peanut

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Posted 19 January 2007 - 05:43 PM

Classes? This is the first I've heard of this? Can someone explain this to me....

You can deprive the body but the soul needs chocolate
my HMO makes me wear a helmet...

#4 JJ-Knitter

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Posted 25 January 2007 - 06:17 AM

Hi Peanut,

WHO classes are World Health Organization Classes (Classification) of severity of PH. I think they are functional based, as in if you are Class I you have no physical limitations and each number higher indicates a worsening. What I don't know and would like to find out is what each level is. Can't seem to find much about it and apparently each class has it's own set of commonly used medications and is (I think) predictive of prognosis. The medical jargon and terminology can really drive you nuts.

JJ

#5 Margaret

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Posted 25 January 2007 - 08:34 AM

JJ....I just read a medscape article on the vascular complications of SS. What I gathered from the article is that The WHO classifications have nothing to do with the severity of the PH, but it is just the doctors trying to get a common understanding of each person's disease for better research/effective communication.

Here are the classes:
Class 1 Pulmonary Arterial Hyperplasia
Class 2 Pulmonary Venous Hyperplasia
Class 3 PH with Lung Diseases/Hypoxemia
Class 4 PH due to Chronic Thrombotic and/or Embolic Disease
Class 5 Miscellaneous


Take care, Everyone.
Margaret

#6 JJ-Knitter

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Posted 26 January 2007 - 01:08 PM

Hi Margaret and all,

No, the WHO classes are descriptions of functional limitations placed on a patient by a disease. I finally found a good article on Medscape by Dr. Michael A. Mathier by doing a web search on "PAH functional class".

It seems that the World Health Organization's classes are expanded descriptions of the New York Heart Association's functional classification system. There are 4 classes and all must have PAH: class I has no limitation of activity (no symptoms) and from there on up there is shortness of breath, fatigue, chest pain and/or faintness or dizziness with less and less activity.

This is relevant to those of us with PAH because the class will often determine the treatment. For instance, the FDA has approved Bosentan for Class III and IV, but not as far as I know for Class I/II. I think more doctors are prescribing it for those classes, though, because it does improve symptoms and possibly has a disease modifying component.

JJ

#7 LizzyC

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Posted 27 January 2007 - 01:51 PM

Here is the official WHO Classifications for Pulmonary Hypertension:

Class I: Patients with pulmonary hypertension but without resulting limitation of physical activity. Ordinary physical activity does not cause undue dyspnea or fatigue, chest pain or near syncope.

Class II: Patients with pulmonary hypertension resulting in slight limitation of physical activity. These patients are comfortable at rest, but ordinary physical activity causes undue dyspnea or fatigue, chest pain or near syncope.

Class III: Patients with pulmonary hypertension resulting in marked limitation of physical activity. These patients are comfortable at rest, but less than ordinary physical activity causes undue dyspnea or fatigue, chest pain or near syncope.

Class IV: Patients with pulmonary hypertension resulting in inability to perform any physical activity without symptoms. These patients manifest signs of right heart failure. Dyspnea and/or fatigue may be present at rest, and discomfort is increased by any physical activity.

dyspnea (DISP-ne-eh). Labored breathing; shortness of breath
syncope (SIN-ko-pee). Fainting because of a temporary insufficiency of blood to the brain.

Love and hugs, Lizzy

#8 Shelley Ensz

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Posted 27 January 2007 - 02:13 PM

I added a link in our Pulmonary Hypertension: Diagnosis section about the World Health Organization Classification of Pulmonary Hypertension, which also has the classes and elaborates a bit on the subject.

See: Pulmonary Hypertension: Diagnosis.


Warm Hugs,

Shelley Ensz
Founder and President
International Scleroderma Network (ISN)
Hotline and Donations: 1-800-564-7099

The most important thing in the world to know about scleroderma is sclero.org.

#9 JJ-Knitter

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Posted 28 January 2007 - 06:05 AM

Thanks everybody, that was what I was looking for!

JJ

#10 Margaret

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Posted 28 January 2007 - 03:33 PM

Hi JJ....I was listing the WHO Pulmonary Hypertension Diagnostic Classifications. I think the key word here is 'diagnostic'......not functioning levels. Sorry....didn't know there was a difference. If you can pull up Medscape articles then read the one from last week on 'Vascular Complications of Systemic Sclerosis'....just Google that article and it will come up. That's where I pulled those Classes from. It's a very educational article!!!
Margaret