Inhaled Iloprost To Treat Severe Pulmonary Hypertension: An Uncontrolled Trial

Olschewski, Horst; Ghofrani, Hossein Ardeschir; Schmehl, Thomas; Winkler, Jörg; Wilkens, Heinrike; Mm, Höper; Behr, Jüergen; Fx, Kleber; Seeger, Werner

doi:10.7326/0003-4819-132-6-200003210-00003

Cited by 247 publications

(131 citation statements)

References 28 publications

Supporting

Mentioning

109

Contrasting

Unclassified

Order By: Relevance

“…4,11,[13][14][15] Several open-label, uncontrolled studies of patients with severe pulmonary hypertension suggested that longterm use of aerosolized iloprost results in substantial clinical improvement. 11,13,[16][17][18][19][20] Our objective in this trial was to evaluate the effects of inhaled iloprost using a rigorous end point of clinical efficacy.…”

Section: Resultsmentioning

confidence: 99%

Inhaled Iloprost for Severe Pulmonary Hypertension

Olschewski¹,

et al. 2002

Self Cite

View full text Add to dashboard Cite

Section: Resultsmentioning

confidence: 99%

Inhaled Iloprost for Severe Pulmonary Hypertension

Olschewski¹,

et al. 2002

Self Cite

View full text Add to dashboard Cite

“…Treatment with prostanoids has been shown to improve prognosis, exercise capacity, and hemodynamic variables. 2,3 The mechanisms of action, however, are not fully understood so far, in addition to vasodilatation antiproliferative effects have been hypothesized. 2 Endothelin-1 (ET-1) is a potent endogenous vasoconstrictor and smooth-muscle mitogen 4 that is overexpressed in the plasma and lung tissue of patients with PAH.…”

mentioning

confidence: 99%

Influence of Inhaled Iloprost on Transpulmonary Gradient of Big Endothelin in Patients With Pulmonary Hypertension

et al. 2003

View full text Add to dashboard Cite

Background-The pulmonary circulation is an important site for the production and clearance of endothelin (ET)-1, a potent vasoactive and mitogenic peptide. In healthy individuals, 40% to 50% of circulating ET-1 is removed on each passage through the lungs resulting in an arteriovenous ratio of Ͻ1, whereas many patients with pulmonary arterial hypertension (PAH) have ratios Ͼ1, indicating reduced clearance or increased release of endothelin. The influence of inhaled prostanoids on endothelin clearance is unknown. Methods and Results-In a prospective investigation, plasma concentrations of big endothelin-1 (big ET-1, Elisa) were measured in 15 patients with pulmonary hypertension undergoing right heart catheterization with iloprost inhalation (4 m, 11 f, aged 35 to 75 years, mean pulmonary arterial pressure (PAPm) 54Ϯ2.3 mm Hg, pulmonary vascular resistance (PVR) 1061Ϯ141 dyn ϫ sec ϫ cm -5 ). There was a significant transpulmonary gradient for big ET-1 with 31% Ϯ11% higher concentrations in the radial artery than in the pulmonary artery (PϽ0.001). After inhalation of iloprost a significant decrease in the AV-ratio from 1.31Ϯ0.11 to 0.92Ϯ0.06 (PϽ0.007) was observed. The pulmonary net release of 3.10Ϯ0.65 pmol/min big ET-1 at baseline decreased to -1.24Ϯ1.32 pmol/min (Pϭ0.013) within 15 minutes indicating a restored balance. Patients under long-term treatment with iloprost (nϭ7) tended to have a lower net release and AV-ratio for big ET-1 than patients without pretreatment. Conclusion-An increase in pulmonary clearance of big-ET could be a mechanism contributing to the beneficial effects of inhaled prostanoids in the treatment of PAH.

show abstract

“…In idiopathic PAH, short-term inhalation of iloprost resulted in greater pulmonary vasodilatation than did nitric oxide (65). For long-term use, the relatively short duration of action of inhaled iloprost necessitates 6 to 9 inhalations per day (66,67). In a 3-month multicenter trial, iloprost administered in a dosage of 2.5 or 5 g 6 or 9 times daily improved the 6-min walking distance and NYHA functional class (68).…”

Section: Prostanoidsmentioning

confidence: 99%

Evaluation and Management of the Patient with Pulmonary Arterial Hypertension

Rubin

Badesch²

2005

Ann Intern Med

126

View full text Add to dashboard Cite

Increased pressure in the pulmonary circulation, or pulmonary hypertension, is a common disorder that may complicate various cardiopulmonary conditions, including severe obstructive airways disease and left ventricular dysfunction. An increase in pulmonary arterial pressure that is not due to coexistent cardiopulmonary disease, known as pulmonary arterial hypertension, may occur in the absence of a demonstrable cause (idiopathic or familial); as a complication of systemic conditions, such as connective tissue disease, HIV infection, or chronic liver disease; or as a result of the use of fenfluramine anorexigens, amphetamines, or cocaine. The development of disease-specific therapies for pulmonary arterial hypertension over the past decade underscores the importance of diagnosing pulmonary hypertension early in the course of the condition and implementing a treatment strategy that is based on the condition's cause and severity. In this review, the authors present approaches to the diagnosis and management of pulmonary arterial hypertension, using a hypothetical case to highlight the key management points. U ntil recently, management of pulmonary arterial hypertension (PAH) was generally ineffective in alleviating symptoms or improving survival. However, the past decade has witnessed remarkable advances in our understanding of the pathogenesis of PAH, advances that have led to the development of disease-specific treatments. Despite these achievements, PAH remains a challenging condition to diagnose and manage. This article reviews recent developments in the diagnosis and management of PAH in the context of a typical case, illustrating the importance of collaboration between the internist and the specialist in patient care.

show abstract

Inhaled Iloprost To Treat Severe Pulmonary Hypertension: An Uncontrolled Trial

Abstract: Inhaled iloprost may offer a new therapeutic option for improvement of hemodynamics and physical function in patients with life-threatening pulmonary hypertension and progressive right-heart failure that is refractory to conventional therapy.

Cited by 247 publications

References 28 publications

Inhaled Iloprost for Severe Pulmonary Hypertension

Inhaled Iloprost for Severe Pulmonary Hypertension

Influence of Inhaled Iloprost on Transpulmonary Gradient of Big Endothelin in Patients With Pulmonary Hypertension

Evaluation and Management of the Patient with Pulmonary Arterial Hypertension

Contact Info

Product

Resources

About