Abstract
BackgroundInhaled iloprost potentially improves hemodynamics and gas exchange in patients with chronic obstructive pulmonary disease (COPD) and secondary pulmonary hypertension (PH).ObjectivesTo evaluate acute effects of aerosolized iloprost in patients with COPD-associated PH.MethodsA randomized, double blind, crossover study was conducted in 16 COPD patients with invasively confirmed PH in a single tertiary care center. Each patient received a single dose of 10 µg iloprost (low dose), 20 µg iloprost (high dose) and placebo during distinct study-visits. The primary end-point of the study was exercise capacity as assessed by the six minute walking distance.ResultsBoth iloprost doses failed to improve six-minute walking distance (p = 0.36). Low dose iloprost (estimated difference of the means −1.0%, p = 0.035) as well as high dose iloprost (−2.2%, p<0.001) significantly impaired oxygenation at rest. Peak oxygen consumption and carbon dioxide production differed significantly over the three study days (p = 0.002 and p = 0.003, accordingly). As compared to placebo, low dose iloprost was associated with reduced peak oxygen consumption (−76 ml/min, p = 0.002), elevated partial pressure of carbon dioxide (0.27 kPa, p = 0.040) and impaired ventilation during exercise (−3.0l/min, p<0.001).ConclusionsImprovement of the exercise capacity after iloprost inhalation in patients with COPD-associated mild to moderate PH is very unlikely.Trial RegistrationControlled-Trials.com ISRCTN61661881
Highlights
Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide [1]
An open-label study reported an improvement in 6 minute walking distance after iloprost inhalation in chronic obstructive pulmonary disease (COPD) patients [20]
The study was designed as a prospective, randomized, doubleblind, single center, cross-over trial comparing two doses of inhaled iloprost (10 mg iloprost = low dose iloprost and 20 mg iloprost = high dose iloprost) and placebo in 16 patients with COPD-associated pulmonary hypertension (PH)
Summary
Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide [1]. Only a few trials investigated pulmonary vasodilators in COPD patients [8,9,10,11]. Pulmonary vasodilators mostly caused an impaired gas exchange and did not improve exercise capacity in COPD. Namely nitric oxide and prostacyclin, have shown to improve oxygenation and pulmonary artery pressure (PAP) in high V/Q mismatch states [12,13]. The selective vasodilative properties of inhaled iloprost, a prostacyclin analogue, were previously investigated in interstitial lung disease [19]. To our knowledge, inhaled prostacyclins have not been investigated in a randomized trial in COPD patients. Inhaled iloprost potentially improves hemodynamics and gas exchange in patients with chronic obstructive pulmonary disease (COPD) and secondary pulmonary hypertension (PH)
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call