Iloprost improves gas exchange and exercise tolerance in patients with pulmonary hypertension and chronic obstructive pulmonary disease.
BACKGROUND
Nonselective systemic vasodilators worsen ventilation perfusion (V/Q) matching and gas exchange in patients with chronic obstructive pulmonary disease (COPD). Inhaled iloprost has the potential to act preferentially in ventilated regions of the lung, thereby reducing pulmonary hypertension (PH) while alveolar ventilation is still maintained.


OBJECTIVE
To investigate the acute effects of inhaled iloprost on V/Q matching in patients with COPD and PH.


METHODS
Ten males with COPD and PH on echocardiography were evaluated before and after inhaling 2 doses of iloprost (2.5 microg). Measurements included lung function, arterial blood gas, 6-min walk test (6MWT) as well as ventilatory equivalents for oxygen (V(E)/VO(2)) and carbon dioxide (V(E)/VCO(2)) taken at baseline, 30 min following each dose of iloprost, and 2 h after the second dose.


RESULTS
Mean differences in V(E)/VCO(2) and V(E)/VO(2) were -13.3 (95% CI -36.5 to -2.7; p = 0.002) and -15.0 (95% CI -36.7 to -0.4; p = 0.02), respectively, and the mean change in (A-a) gradient was -3.7 mm Hg (95% CI -6.1 to -1.0; p = 0.01) after a single dose of iloprost, whereas mean improvement in 6MWT was 49.8 m (95% CI 14.8 to 84.7; p = 0.02). Arterial blood gas, venous admixture, dead space fraction and lung functions were maintained after iloprost. The effects of iloprost were reproducible after the second dose. All measurements returned to baseline 2 h after the last dose. No adverse effects on systemic blood pressure or oxygen saturation were seen.


CONCLUSIONS
Iloprost inhalation was safe in patients with COPD and PH, and was associated with improved V/Q matching and exercise tolerance.
University of Oklahoma Health Sciences Center, Pulmonary and Critical Care Medicine, Oklahoma City, OK 73104, USA. tarek-dernaika@ouhsc.edu
Tarek A
TA
Dernaika
Mikel
M
Beavin
Gary T
GT
Kinasewitz
D000280:Administration, Inhalation; D000368:Aged; D001784:Blood Gas Analysis; D017079:Exercise Tolerance; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy*; D016285:Iloprost / Q000627:therapeutic use*; D008297:Male; D009330:Nebulizers and Vaporizers; D010101:Oxygen Consumption; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy*; D011659:Pulmonary Gas Exchange; D014665:Vasodilator Agents / Q000627:therapeutic use*
D014665:Vasodilator Agents; D016285:Iloprost