Acute Hemodynamic Effects of Nebulized Iloprost via the I‐Neb Adaptive Aerosol Delivery System in Pulmonary Hypertension

Abstract

Inhaled iloprost has proven to be an effective therapy in patients with pulmonary hypertension (PH). However, the acute hemodynamic effect of nebulized iloprost delivered via the I-neb Adaptive Aerosol Delivery (AAD) system remains unclear and needs to be assessed. In this study, 126 patients with PH were classified according to current guidelines (59, 34, 29, and 4 patients in groups 1/1′, 3, 4, and 5, respectively; 20 patients had idiopathic pulmonary arterial hypertension [iPAH]), were randomly assigned to inhale iloprost 2.5 μg (n ¼ 67) or 5.0 μg (n ¼ 59) via the I-neb AAD system, and were assessed by right heart catheterization. In seven patients with iPAH, iloprost plasma levels were measured. The two iloprost doses caused decreases from baseline in pulmonary vascular resistance (PVR; 2.5 μg: -14.7%; 5.0 μg: -15.6%) and mean pulmonary arterial pressure (mPAP; 2.5 μg: -11.0%; 5.0 μg: -10.1%) while cardiac index (CI) increased (2.5 μg: þ6.5%; 5.0 μg: þ6.4%). The subset with iPAH also showed decreases from baseline in PVR and mPAP and an increase in CI. Peak iloprost plasma levels showed no significant difference after inhalation of 2.5 μg or 5.0 μg iloprost (95.5 pg/mL vs. 73.0 pg/mL; P ¼ 0.06). In summary, nebulized iloprost delivered via the I-neb AAD system reduced mPAP and PVR and increased CI from baseline in a heterogeneous group of patients with PH and in the subset with iPAH. In patients with iPAH, inhalation of 2.5 μg or 5.0 μg iloprost resulted in broadly similar peak iloprost plasma levels.

Bronchodilation induced by PGE2 is impaired in Group III pulmonary hypertension

“…The respiratory function data presented from the TRIUMPH study are comparable to data from other studies of nebulized iloprost in PH Group III patients (Dernaika, Beavin, & Kinasewitz, ; Hegewald & Elliott, ; Lasota, Skoczynski, Mizia‐Stec, & Pierzchala, ; Olschewski et al, ; Reichenberger et al, ; Richter et al, ). Iloprost treatment demonstrated an absence of effect (or a trend to improvement) on respiratory function and/or oxygenation (Dernaika et al, ; Hegewald & Elliott, ; Lasota et al, ; Reichenberger et al, ) and was associated with functional improvement (mPAP and 6MWD) in most of the PH Group III patients with severe PH (mPAP >35 mmHg).…”

Hemodynamic and gas exchange effects of inhaled iloprost in patients with COPD and pulmonary hypertension

“…The major limitation of this study just like other published experiences 12 , 22 , 23 was its short-term design, which restricts findings to only the acute effects of iloprost. In COPD, pulmonary vasodilation without deterioration of gas exchange is challenging caused by the presence of low ventilation/perfusion ratio areas.…”

The optimization of iloprost inhalation under moderate flow of oxygen therapy in severe pulmonary arterial hypertension

“…Similarly, Richter et al. 13 also reported 5 min from the end of inhalation with 5.0 µg iloprost (n = 12 of IPAH) as the maximum effect. However, they also reported the maximum effect of 2.5 µg iloprost was observed at 30 min (n = 8 of IPAH), which is similar with our data ( Table 1 ).…”