Background: Ppao values are routinely used to assess pulmonary vascular status and LV performance. Regrettably, under many common clinically relevant conditions, even when Ppao values are measured accurately, Ppao values at baseline and in response to therapy often reflect an inaccurate measure of cardiovascular status. Results and conclusions: Thus, caution should be used when applying measures of Ppao in determining therapy if changes in RV volume, hyperinflation, or LV diastolic compliance are simultaneously occurring.