The use of iloprost in the treatment of ‘out of proportion’ pulmonary hypertension in chronic obstructive pulmonary disease

Abstract

Case Pulmonary hypertension secondary to respiratory disease most often occurs as a complication of chronic obstructive pulmonary disease, which currently constitutes one of the leading causes of death. Some patients with hypoxaemia reveal “out of proportion” pulmonary hypertension with inappropriate increase of pulmonary artery pressure. Iloprost, analogue of prostacyclin, dilates systemic vessels and pulmonary vessels in particular if administered by inhalation. It appears to be important, life-saving, complementary therapy. However, there is no evidence for its routine use in out of proportion arterial pulmonary hypertension. This case study presents a 44-year old man with chronic obstructive pulmonary disease and “out of proportion” pulmonary hypertension. We present the results of his treatment with iloprost. Conclusion In a patient with “out of proportion” pulmonary hypertension due to chronic obstructive pulmonary disease, inhaled iloprost led to improvement in clinical status and echocardiographic parameters, including a reduction of right ventricular systolic pressure.

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

“…21 However, there is no evidence for routine use of inhaled iloprost in patients with CTEPH or LD-PH, even in cases of "out of proportion" PH, and evidence regarding its application in these patients is limited to case studies. 1,17,22,23 In patients with iPAH, the dose-dependent reduction of PVR with enhancement of CI and the corresponding iloprost plasma levels are in line with already-published data, underlining the efficacy of inhaled iloprost despite different forms of application. 12 The maximum plasma iloprost levels found in our cohort were lower than those recorded by Olschewski et al 12 due to the different radioimmunoassay used in our study, with a lower threshold value.…”

“…Additionally, the timing of the PaO 2 sampling with respect to peak or trough levels was not exactly defined 21 . However, there is no evidence for routine use of inhaled iloprost in patients with CTEPH or LD‐PH, even in cases of “out of proportion” PH, and evidence regarding its application in these patients is limited to case studies 1 , 17 , 22 , 23 …”

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). However, high doses of PGI 2 analogues could induce airway irritation in some patients (Reichenberger et al, ).…”

Severe Pulmonary Hypertension Associated with COPD: Hemodynamic Improvement with Specific Therapy

“…In another nonrandomized study of patients with COPD-PH [19], bosentan therapy was followed by significant improvement in hemodynamics and 6MWD, with especially favorable effect in those with COPD stage GOLD III or IV. Benefit from PH therapy has been reported in isolated cases [35,36,37]; however, initiation of therapy was sometimes concomitant with supplemental oxygen supplementation, limiting interpretation of data. The short-term use of sildenafil [20,21,22] or inhaled iloprost [24] were found to improve hemodynamics; however, with unclear clinical benefit.…”