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

Abstract

Inhaled iloprost efficiently improves pulmonary hemodynamics, exercise capacity, and quality of life in patients with pulmonary arterial hypertension (PAH). However, the process of inhalation is laborious for patients suffering from resting dyspnea. We describe a 75-year-old man with idiopathic PAH and a low gas transfer. Investigations excluded significant parenchymal lung disease and airflow obstruction (presuming FEV1/FVC ration > 70%). The patient struggled to complete iloprost inhalation due to severe dyspnea and hypoxemia. As such, we optimized the methods of oxygen supply from the nasal cannula to the trans-inhalator during the inhalation. We successfully shortened the inhalation duration that effectively reduced the laborious efforts required of patients. We also recorded pulmonary hemodynamics during inhalation of nebulized iloprost. This revealed significant hemodynamic improvement immediately following inhalation but hemodynamics returned to baseline within 2 hours. We hope that this optimization will enable patients with severe PAH to undergo iloprost inhalation.

Real-world experience of selexipag titration in pulmonary arterial hypertension

“…19 Aerosolised iloprost is generally well tolerated as it typically avoids the systemic side effects of IV, subcutaneous or oral routes of prostacyclin administration, however there is some evidence that the cessation of iloprost overnight is associated with a deterioration in hemodynamic parameters. 20 In our cohort two patients transitioned from inhaled iloprost by reducing the frequency of drug administration, rather than reducing the dose administered or duration of treatment sessions. This method was well tolerated, with complete drug cessation by week 3 in both cases.…”

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

“…Its delivery is simple, cost-effective, and predictable compared to NO and epoprostenol [22]. Recently, new devices and formulations have been introduced to increase drug deposition and plasma levels of iloprost while shortening inhalation time [24,25,26]. Currently, application of these methods in the operating room setting during anesthesia is challenging.…”

Acute response to rapid iloprost inhalation using the Breelib™ nebulizer in pulmonary arterial hypertension: the Breelib™ acute study

“…3,4 There has been much interest in approaches to reduce inhalation times and thus improve treatment convenience and adherence, with examples including a change in the iloprost formulation 5 and unapproved modification of the I-neb device. 6 The Breelib TM nebulizer (Vectura Group plc, Chippenham, UK) was approved in the EU in 2016. 7 Compared with I-neb, Breelib TM resulted in substantially reduced median inhalation times.…”