Long-term treatment of primary pulmonary hypertension with aerosolized iloprost, a prostacyclin analogue.
BACKGROUND
Continuous intravenous infusion of epoprostenol (prostacyclin) is an effective treatment for primary pulmonary hypertension. This approach requires the insertion of a permanent central venous catheter, with the associated risk of serious complications. Recently, aerosolized iloprost, a stable prostacyclin analogue, has been introduced as an alternative therapy for severe pulmonary hypertension.


METHODS
We evaluated the effects of aerosolized iloprost on exercise capacity and hemodynamic variables over a one-year period in patients with primary pulmonary hypertension.


RESULTS
Twenty-four patients with primary pulmonary hypertension received aerosolized iloprost at a daily dose of 100 or 150 microg for at least one year. The mean (+/-SD) distance covered in the six-minute walk test increased from 278+/-96 m at base line to 363+/-135 m after 12 months (P<0.001). During the same period, the mean pulmonary arterial pressure before the inhalation of iloprost declined from 59+/-10 mm Hg to 52+/-15 mm Hg (P=0.006), cardiac output increased from 3.8+/-1.4 liters per minute to 4.4+/-1.3 liters per minute (P=0.02), and pulmonary vascular resistance declined from 1205+/-467 dyn x sec x cm(-5) to 925+/-469 dyn x sec x cm(-5) (P<0.001). The treatment was generally well tolerated, except for mild coughing, minor headache, and jaw pain in some patients.


CONCLUSIONS
Long-term treatment with aerosolized iloprost is safe and has sustained effects on exercise capacity and pulmonary hemodynamics in patients with primary pulmonary hypertension.
Hoeper
M M
MM
Department of Respiratory Medicine, Hannover Medical School, Germany. kmhoeper@aol.com
Schwarze
M
M
Ehlerding
S
S
Adler-Schuermeyer
A
A
Spiekerkoetter
E
E
Niedermeyer
J
J
Hamm
M
M
Fabel
H
H
D000280:Administration, Inhalation; D000328:Adult; D000336:Aerosols; D000368:Aged; D017079:Exercise Tolerance / Q000187:drug effects; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy* / Q000503:physiopathology; D016285:Iloprost / Q000008:administration & dosage* / Q000009:adverse effects / Q000494:pharmacology; D008875:Middle Aged; D014665:Vasodilator Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000494:pharmacology
D000336:Aerosols; D014665:Vasodilator Agents; D016285:Iloprost