Brief Communications
1 May 1996

Aerosolized Prostacyclin and Iloprost in Severe Pulmonary Hypertension

Publication: Annals of Internal Medicine
Volume 124, Number 9

Abstract

Objective:

To compare the effects of aerosolization of prostacyclin and its stable analog iloprost with those of nasal oxygen, inhaled nitric oxide, and intravenous prostacyclin on hemodynamics and gas exchange in patients with severe pulmonary hypertension.

Design:

Open uncontrolled trial.

Setting:

Justus-Liebig-University, Giessen, Germany.

Patients:

4 patients with primary pulmonary hypertension and 2 patients with severe pulmonary hypertension associated with calcinosis, the Raynaud phenomenon, esophageal dysfunction, sclerodactyly, and telangiectasia (the CREST syndrome). All were classified as New York Heart Association class III or class IV.

Intervention:

Short-term applications of O2, inhaled nitric oxide, intravenous prostacyclin, aerosolized prostacyclin, and aerosolized iloprost during repeated catheter investigation of the right side of the heart within a 1-month period. One patient had long-term therapy with inhaled iloprost.

Results:

Aerosolized prostacyclin decreased pulmonary artery pressure in 6 patients from (mean ± SE) 62.3 ± 4.1 mm Hg to 50.8 ± 5.5 mm Hg and reduced pulmonary vascular resistance from 1721 ± 253 dyne/s · cm−5 to 1019 ± 203 dyne/s · cm−5, and it increased cardiac output from 2.75 ± 0.21 L/min to 4.11 ± 0.54 L/min, mixed venous oxygen saturation from 51.1% ± 3.4% to 66.3% ± 4.1%, and arterial oxygen saturation from 90.6% ± 2.7% to 93.8% ± 23% (P < 0.05 for all changes). Mean systemic arterial pressure was only slightly affected. The responses lasted for 10 to 30 minutes after inhalation was terminated. Aerosolized iloprost had an identical efficacy profile but was associated with a longer duration of the pulmonary vasodilatory effect (60 min to 120 min). In comparison, intravenous prostacyclin reduced pulmonary vascular resistance with corresponding efficacy but produced a more pronounced decline in systemic artery pressure and no clinically significant decrease in pulmonary artery pressure. Nitric oxide and O2 were less potent pulmonary vasodilators in these patients. In one patient, 1 year of therapy with aerosolized iloprost (100 µg/d in six aerosol doses) resulted in sustained efficacy of the inhaled vasodilator regimen and clinical improvement.

Conclusion:

Aerosolization of prostacyclin or its stable analog iloprost causes selective pulmonary vasodilatation, increases cardiac output, and improves venous and arterial oxygenation in patients with severe pulmonary hypertension. Thus, it may offer a new strategy for treatment of this disease.

Get full access to this article

View all available purchase options and get full access to this article.

References

1.
D'Alonzo GE, Barst RJ, Ayres SM, Bergofsky E, Brundage BH, Detre KM, et al. Survival in patients with primary pulmonary hypertension. Results from a national prospective registry. Ann Intern Med. 1991; 115:343-9.
2.
Rich S, Kaufmann E, Levy PS. The effect of high doses of calcium-channel blockers on survival in primary pulmonary hypertension. N Engl J Med. 1992; 327:76-81.
3.
Higenbottam T, Wheeldon D, Wells F, Wallwork J. Long-term treatment of primary pulmonary hypertension with continuous intravenous epoprostenol (prostacyclin). Lancet. 1984; 1:1046-7.
4.
Higenbottam T. The place of prostacyclin in the clinical management of primary pulmonary hypertension. Am Rev Respir Dis. 1987; 136:782-5.
5.
Rubin LI, Mendoza J, Hood M, McGoon M, Barst R, Williams WB, et al. Treatment of primary pulmonary hypertension with continuous intravenous prostacyclin (epoprostenol). Results of a randomized trial. Ann Intern Med. 1990; 112:485-91.
6.
Barst RJ, Rubin LJ, McGoon MD, Caldwell EJ, Long WA, Levy PS. Survival in primary pulmonary hypertension with long-term continuous intravenous prostacyclin. Ann Intern Med. 1994; 121:409-15.
7.
Walmrath D, Schneider T, Pilch J, Grimminger F, Seeger W. Aerosolised prostacyclin in adult respiratory distress syndrome. Lancet. 1993; 342:961-2.
8.
Welte M, Zwissler B, Habazettl H, Messmer K. PG12 aerosol versus nitric oxide for selective pulmonary vasodilation in hypoxic pulmonary vasoconstriction. Eur Surg Res. 1993; 25:329-40.
9.
Pepke-Zaba J, Higenbottam TW, Dinh-Xuan AT, Stone D, Wallwork J. Inhaled nitric oxide as a cause of selective pulmonary vasodilatation in pulmonary hypertension. Lancet. 1991; 338:1173-4.
10.
Zapol WM, Rimar S, Gillis N, Marletta M, Bosken CH. Nitric oxide and the lung. Am J Respir Crit Care Med. 1994; 149:1375-80.

Comments

0 Comments
Sign In to Submit A Comment

Information & Authors

Information

Published In

cover image Annals of Internal Medicine
Annals of Internal Medicine
Volume 124Number 91 May 1996
Pages: 820 - 824

History

Published in issue: 1 May 1996
Published online: 15 August 2000

Keywords

Authors

Affiliations

Horst Olschewski, MD
From Justus-Liebig-University, Giessen, Germany.
Dieter Walmrath, MD
From Justus-Liebig-University, Giessen, Germany.
Ralph Schermuly, PhD
From Justus-Liebig-University, Giessen, Germany.
H. Ardeshir Ghofrani, MD
From Justus-Liebig-University, Giessen, Germany.
Friedrich Grimminger, MD, PhD
From Justus-Liebig-University, Giessen, Germany.
Werner Seeger, MD
From Justus-Liebig-University, Giessen, Germany.
Acknowledgments: The authors thank Dr. R.H. Bodeker, Institute of Medical Statistics, for statistical discussion and Dr. R. Snipes, Institute of Anatomy, Justus-Liebig-University, Giessen, Germany, for linguistic revision of the manuscript.
Corresponding Author: Werner Seeger, MD, Department of Medicine, Justus-Liebig-University, Klinikstrasse 36, D-35392 Giessen, Germany.
Current Author Addresses: Drs. Olschewski, Walmrath, Schermuly, Ghofrani, Grimminger, and Seeger: Department of Medicine, Justus-Liebig-University, Klinikstrasse 36, D-35392 Giessen, Germany.

Metrics & Citations

Metrics

Citations

If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. For an editable text file, please select Medlars format which will download as a .txt file. Simply select your manager software from the list below and click Download.

For more information or tips please see 'Downloading to a citation manager' in the Help menu.

Format





Download article citation data for:
Horst Olschewski, Dieter Walmrath, Ralph Schermuly, et al. Aerosolized Prostacyclin and Iloprost in Severe Pulmonary Hypertension. Ann Intern Med.1996;124:820-824. doi:10.7326/0003-4819-124-9-199605010-00006

View More

Login Options:
Purchase

You will be redirected to acponline.org to sign-in to Annals to complete your purchase.

Access to EPUBs and PDFs for FREE Annals content requires users to be registered and logged in. A subscription is not required. You can create a free account below or from the following link. You will be redirected to acponline.org to create an account that will provide access to Annals. If you are accessing the Free Annals content via your institution's access, registration is not required.

Create your Free Account

You will be redirected to acponline.org to create an account that will provide access to Annals.

View options

PDF/EPUB

View PDF/EPUB

Related in ACP Journals

Full Text

View Full Text

Figures

Tables

Media

Share

Share

Copy the content Link

Share on social media