The Effect of Inhaled Nitric Oxide on 6-Minute Walk Distance in Patients With Pulmonary Hypertension

Parsons, S. T.; Celermajer, David; Savidis, E.; Miller, Owen; Young, Iven H.

doi:10.1378/chest.114.1_supplement.70s

Cited by 6 publications

(5 citation statements)

References 8 publications

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“…The safety profile of inhaled nitric oxide (iNO) at doses of 45 and 75 mcg/IBW/h has been demonstrated to be favorable in the current study, with no serious side effects observed during the relatively brief treatment period of 30 minutes. This aligns with the findings from multiple previous trials that have also reported a positive safety profile for iNO therapy [3,8,[15][16][17][29][30][31][32][33]. Considering that the efficacy of iNO therapy in treating ILD and PH-ILD has not yet been conclusively established, this study underscores the feasibility of future trials aimed at exploring higher doses and extended treatment durations with iNO.…”

Section: Discussionsupporting

confidence: 87%

“…Our study revealed that iNO does not confer an immediate benefit, suggesting that the treatment may not be effective in ILD or that a longer duration of administration or a higher dose might be necessary to observe benefits. This lack of effect of iNO therapy was also observed in patients with primary pulmonary hypertension (PH) and PH secondary to cystic fibrosis [8,33]. However, this is in contrast to chronic obstructive pulmonary disease (COPD), in which there is evidence suggesting that iNO increases 6MWTD and improves shortness of breath at rest and during exercise [30,32].…”

Section: Discussionmentioning

confidence: 96%

“…Unlike intravenous vasodilators, which can compromise hemodynamic stability, iNO reduces pulmonary vascular resistance and intrapulmonary shunt without affecting other organs [3][4][5]. Early randomized controlled trials (RCTs) in patients with pulmonary hypertension, including pediatric and adult populations [6][7][8], demonstrated the safety and efficacy of iNO and laid the foundation for subsequent studies exploring its benefits in diverse pulmonary, cardiac, and vascular conditions [9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

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The acute effect of inhaled nitric oxide on the exercise capacity of patients with advanced interstitial lung disease: a randomized controlled trial

Freidkin,

Kramer,

Rosengarten

et al. 2024

BMC Pulm Med

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Background Inhaled nitric oxide (iNO) selectively acts on the pulmonary vasculature of ventilated lung tissue by reducing pulmonary vascular resistance and intrapulmonary shunt. This effect may reduce ventilation/perfusion mismatch and decrease pulmonary hypertension in patients with interstitial lung disease. Methods In a prospective, single-blinded, randomized, placebo-controlled trial, participants with advanced interstitial lung disease, underwent two separate six-minute walk tests (6MWT): one with iNO and the other with a placebo. The primary outcome measured the difference in meters between the distances covered in the two tests. Secondary outcomes included oxygen saturation levels, distance-saturation product, and Borg dyspnea score. A predefined subgroup analysis was conducted for patients with pulmonary hypertension. Results Overall, 44 patients were included in the final analysis. The 6MWT distance was similar for iNO treatment and placebo, median 362 m (IQR 265-409) vs 371 m (IQR 250-407), respectively (p = 0.29). Subgroup analysis for patients with pulmonary hypertension showed no difference in 6MWT distance with iNO and placebo, median 339 (256-402) vs 332 (238-403) for the iNO and placebo tests respectively (P=0.50). No correlation was observed between mean pulmonary artery pressure values and the change in 6MWT distance with iNO versus placebo (spearman correlation Coefficient 0.24, P=0.33). Conclusion In patients with advanced interstitial lung disease, both with and without concurrent pulmonary hypertension, the administration of inhaled nitric oxide failed to elicit beneficial effects on the six-minute walk distance and oxygen saturation. The use of inhaled NO was found to be safe and did not lead to any serious side effects. Trial registration (NCT03873298, MOH_2018-04-24_002331).

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

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The acute effect of inhaled nitric oxide on the exercise capacity of patients with advanced interstitial lung disease: a randomized controlled trial

Freidkin,

Kramer,

Rosengarten

et al. 2024

BMC Pulm Med

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“…В связи с ограниченным числом работ по изучению влияния длительной ингаляции NO на толерантность к физической нагрузке, мы сравнили полученные нами данные с результатами исследования Parsons S. и соавт. [7]. При сравнении дистанции в 6MWT, проходимой больными при дыхании обычным воздухом и NO, авторы не получили статистически значимых различий по 6MWT (543±83 против 540±79,6м; р>0,05).…”

Section: Discussionunclassified

Inhaled Nitric Oxide: Clinical Effects and Influence on the Profile of Inflammatory Markers in Patients With Idiopathic Pulmonary Hypertension

Martynyuk

Наконечников

Масенко

et al. 2012

Racionalʹnaâ farmakoterapiâ v kardiologii

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Институт клинической кардиологии им. А.Л. Мясникова, Российский кардиологический научно-производственный комплекс. 121552, Москва, ул. 3-я Черепковская, 15а Ингаляционный оксид азота: клинические эффекты и влияние на профиль провоспалительных маркеров у пациентов с идиопатической легочной гипертензией Т.В. Мартынюк*, С.Н. Наконечников, В.П. Масенко, И.Е. Чазова Институт клинической кардиологии им. А.Л. Мясникова, Российский кардиологический научно-производственный комплекс. 121552, Москва, ул. 3-я Черепковская, 15аЦель. Изучить влияния курсовой терапии ингаляционным оксидом азота (iNO) на клинический статус пациентов с идиопатической легочной гипертензией (ИЛГ), а также -профиль провоспалительных цитокинов в периферической крови. Материал и методы. В исследование включено 48 пациентов с ИЛГ. Исходно и на 21 день терапии iNO у больных оценивали функциональный класс (ФК) легочной гипертензии, проводили тест 6-минутной ходьбы (6MWT) с оценкой индекса по Боргу, ЭхоКГ, лабораторные исследования (клинический анализ крови, определение высокочувствительного С-реактивного белка (вчСРБ), уровней интерлейкинов (IL), интерферона γ (INFγ), фактора некроза опухоли a (TNFa), макрофагального воспалительного протеина a (MIP1a), растворимых молекул адгезии (sICAM-1, sVCAM-1) в периферической крови). Курсовое лечение iNO 40 ppm (parts per million -40 частей NO на миллион частей воздуха) 5 ч в сутки в течение 21 дня проводили под контролем токсичности на приборе PrinterNOx (Англия) на фоне приема стандартной терапии ИЛГ. Результаты. В результате терапии iNO у больных ИЛГ отмечалось повышение толерантности к физической нагрузке, улучшение ФК (с 3,35±0,52 до 2,71±0,56; р=0,008), снижение систолического давления в легочной артерии (СДЛА) по данным ДопплерЭхоКГ (с 96,23±23,65 до 82,36±20,92 мм рт.ст.; p<0,05). При оценке исходных уровней провоспалительных цитокинов у больных ИЛГ удалось подтвердить значимость процессов воспаления в патогенезе заболевания. В результате 21-дневной ингаляционной терапии NO у больных ИЛГ отмечалось значимое снижение уровней провоспалительных цитокинов -IL-1β, IL-6, IL-8, TNFa. У больных с ФК II в результате терапии iNO была выявлена существенная динамика IL-1β и sVCAM, при ФК III-IV -уменьшение содержания IL-8 и TNFa и повышение INFγ (р<0,05). Изменения IL-1β и sVCAM (ΔIL-1β и ΔsVCAM) к 21 дню терапии по сравнению с исходным коррелировали с ΔСДЛА, а ΔIL-6 -с ΔФК и Δдистанции 6MWT (30,5 [21,0; 53,0] м; p<0,001), что позволяет рассматривать указанные показатели в качестве маркеров эффективности терапии iNO. Заключение. Ингаляционная терапия NO у больных ИЛГ в течение 21 дня способствовала значительному улучшению функционального статуса, снижению СДЛА и вызывала позитивную динамику уровней провоспалительных цитокинов в крови.

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“…Inhaled NO is also a potential therapeutic vasodilator of the pulmonary circulation and has been evaluated in preliminary studies as a treatment for pulmonary vascular disease, sometimes in combination with prostacyclin [41]. Insufficient data are yet available to make a final judgement concerning its usefulness but it has shown promise in some of the reported studies [42,43].…”

Section: Nitric Oxidementioning

confidence: 99%

Novel therapeutic strategies in scleroderma

Denton

Black

1999

Curr Rheumatol Rep

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Optimal management for scleroderma (systemic sclerosis) is likely to require treatment of the underlying disease process, which remains incompletely understood, and also of the organ-based complications of this heterogeneous condition. Clinical trials evaluating several potential agents have been completed recently, including D-penicillamine and interferon alpha. Unfortunately none of these studies has suggested significant efficacy. This article focuses on new treatment approaches using existing therapeutic agents, such as prostacyclin, and considers the potential usefulness of new agents (eg, relaxin, halofuginone) or strategies such as intensive immunosuppression with peripheral stem cell rescue. Ultimately, a better understanding of disease pathogenesis may facilitate the development of targeted therapy against key events or mediators, but for the present better evaluation of existing agents and a focus on optimizing protocols for organ-based complications, such as pulmonary vascular disease or hypertensive renal crisis, are important goals.

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The Effect of Inhaled Nitric Oxide on 6-Minute Walk Distance in Patients With Pulmonary Hypertension

Cited by 6 publications

References 8 publications

The acute effect of inhaled nitric oxide on the exercise capacity of patients with advanced interstitial lung disease: a randomized controlled trial

The acute effect of inhaled nitric oxide on the exercise capacity of patients with advanced interstitial lung disease: a randomized controlled trial

Inhaled Nitric Oxide: Clinical Effects and Influence on the Profile of Inflammatory Markers in Patients With Idiopathic Pulmonary Hypertension

Novel therapeutic strategies in scleroderma

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