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

Wang, Lan; Jin, Yuanzhe; Zhao, Qin‐Hua; Jiang, Rong; Wu, Wenhui; Gong, Shan Shan; He, Jing; Jing, Zhi-Cheng

doi:10.2147/copd.s141798

Cited by 31 publications

(35 citation statements)

References 27 publications

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“…In fact, functional respiratory imaging analysis demonstrated that there was a significant association between regional ventilation and regional vasodilation during iNO therapy. While it could be argued that the lack of a familiarisation 6MWD might have overestimated the clinical response to iNO, the physiological rationale was confirmed and the results are in line with that of recent studies investigating the effects of inhaled iloprost in COPD [100].…”

Section: Advances In Exercise Pathophysiologysupporting

confidence: 82%

Highlights from the 2018 European Respiratory Society International Congress: sleep and clinical physiology

et al. 2019

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The 2018 European Respiratory Society (ERS) International Congress held in Paris, France, served as a platform to discover the latest research on respiratory diseases, the improvement in their treatments and patient care. Specifically, the scientific sessions organised by ERS Assembly 4 provided novel insights into sleep disordered breathing and fresh knowledge in respiratory physiology, stressing its importance to understanding and treating respiratory diseases. This article, divided by session, will summarise the most relevant studies presented at the ERS International Congress. Each session has been written by early career members specialised in the different fields of this interdisciplinary assembly.

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Section: Advances In Exercise Pathophysiologysupporting

confidence: 82%

Highlights from the 2018 European Respiratory Society International Congress: sleep and clinical physiology

et al. 2019

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“…Inhaled iloprost resulted in improved gas exchange, without any detrimental effects on pulmonary mechanics nor systemic hemodynamics in ARDS and COPD patients with pulmonary hypertension [4,6]. However, in other studies on patients with COPD and pulmonary hypertension, inhaled iloprost not only failed to improve oxygenation and exercise capacity but, in fact, worsened oxygenation in patients with mild to moderate pulmonary hypertension [8,9]. In studies that demonstrated an improvement, the authors assumed that iloprost was delivered predominantly to the well-ventilated areas of the lung, thus preferentially vasodilating those areas and resulting in decreased ventilation/perfusion (V/Q) mismatch.…”

Section: Discussionmentioning

confidence: 99%

The Effects of Iloprost on Oxygenation During One-Lung Ventilation for Lung Surgery: A Randomized Controlled Trial

Choi

Jeon

Huh

et al. 2019

JCM

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Hypoxemia can occur during one-lung ventilation (OLV) in thoracic surgery, leading to perioperative complications. Inhaled iloprost is a selective pulmonary vasodilator with efficacy in patients with pulmonary hypertension. The purpose of this study was to evaluate the effects of off-label inhaled iloprost on oxygenation during OLV in patients undergoing lung surgery. Seventy-two patients who were scheduled for elective video-assisted thoracoscopic lobectomy were assigned to receive an inhaled nebulizer of distilled water (control group), 10 μg iloprost (IL10 group), or 20 μg iloprost (IL20 group). Arterial and venous blood gas and hemodynamic analyses were obtained. Changes in partial pressure of oxygen in arterial blood (PaO2), after the initiation of OLV and the resumption two-lung ventilation (TLV), were similar in all three groups. However, PaO2 in the IL10 group was comparable to that in the control group, whereas PaO2 in the IL20 group was significantly higher than that in the control group at 10, 20, and 30 min after administration of iloprost (275.1 ± 50.8 vs. 179.3 ± 38.9, p < 0.0001; 233.9 ± 39.7 vs. 155.1 ± 26.5, p < 0.0001; and 224.6 ± 36.4 vs. 144.0 ± 22.9, p < 0.0001, respectively). The shunt fraction in the IL20 group was significantly higher than that in the control group after administration of iloprost (26.8 ± 3.1 vs. 32.2 ± 3.4, p < 0.0001; 24.6 ± 2.2 vs. 29.9 ± 3.4, p < 0.0001; and 25.3 ± 2.0 vs. 30.8 ± 3.1, p < 0.0001, respectively). Administration of inhaled iloprost during OLV improves oxygenation and decreases intrapulmonary shunt.

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“…The non-severe COPD-PH subgroup was defined as patients with an mPAP of 25–35 mm Hg with a normal CI. 29 , 30 …”

Section: Methodsmentioning

confidence: 99%

miR-190a-5p participates in the regulation of hypoxia-induced pulmonary hypertension by targeting KLF15 and can serve as a biomarker of diagnosis and prognosis in chronic obstructive pulmonary disease complicated with pulmonary hypertension

Jiang

Xia

Liang

et al. 2018

COPD

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PurposemiR-190a-5p expression alters dynamically in response to hypoxia. However, the role of miR-190a-5p expression in hypoxia-induced pulmonary hypertension (PH) remains unclear. We sought to correlate the miR-190a-5p expression levels with the severity, diagnosis, and prognosis of PH in relation to chronic obstructive pulmonary disease (COPD-PH). Additionally, we evaluated the effect of miR-190a-5p through in vitro experiments on human pulmonary endothelial cells (HPECs) that were exposed to hypoxia and in vivo experiments using an animal model of hypoxia-induced PH.MethodsCirculating miR-190a-5p levels were measured from 73 patients with PH and 32 healthy controls through quantitative real-time PCR. The levels of miR-190a-5p and the expression of Krüppel-like factor 15 (KLF15) were analyzed in HPECs that were exposed to hypoxia, and the effects of antagomir-190a-5p in mice with chronic hypoxia-induced PH were tested. Target gene analysis was performed by Western blot and luciferase assay.ResultsThe miR-190a-5p level was significantly higher in patients with COPD-PH than in the healthy controls. Higher miR-190a-5p levels were associated with a greater severity of COPD-PH. In vitro experiments on HPECs showed that exposure to hypoxia increased the miR-190a-5p levels significantly. KLF15 was validated as a target of miR-190a-5p. Transfection with miR-190a-5p mimicked inhibition of KLF15 expression in HPECs. In the mouse model of PH, antagomir-190a-5p reduced right ventricular systolic pressure and enhanced the KLF15 expression levels in lung tissue.ConclusionmiR-190a-5p regulates hypoxia-induced PH by targeting KLF15. The circulating levels of miR-190a-5p correlate with the severity of COPD-PH, thereby confirming the diagnostic and prognostic value of this parameter in COPD-PH.

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

Cited by 31 publications

References 27 publications

Highlights from the 2018 European Respiratory Society International Congress: sleep and clinical physiology

Highlights from the 2018 European Respiratory Society International Congress: sleep and clinical physiology

The Effects of Iloprost on Oxygenation During One-Lung Ventilation for Lung Surgery: A Randomized Controlled Trial

miR-190a-5p participates in the regulation of hypoxia-induced pulmonary hypertension by targeting KLF15 and can serve as a biomarker of diagnosis and prognosis in chronic obstructive pulmonary disease complicated with pulmonary hypertension

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