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Pulmonary vascular effects of pulsed inhaled nitric oxide in COPD patients with pulmonary hypertension.

Hajian B, De Backer J, Vos W, Van Holsbeke C, Ferreira F, Quinn DA, Hufkens A, Claes R, De Backer W - Int J Chron Obstruct Pulmon Dis (2016)

Bottom Line: Patients did not develop oxygen desaturation, remained normotensive, and perceived an improvement in their dyspnea sensation.A high degree of heterogeneity was found in the level of vasodilation.Patients tend to feel better after the treatment.

View Article: PubMed Central - PubMed

Affiliation: Department of Respiratory Medicine, University Hospital Antwerp, Edegem.

ABSTRACT

Introduction: Severe chronic obstructive pulmonary disease (COPD) is often associated with secondary pulmonary hypertension (PH), which worsens prognosis. PH can be lowered by oxygen, but also by inhaled nitric oxide (NO), which has the potential to improve the health status of these patients. NO is an important mediator in vascular reactions in the pulmonary circulation. Oral compounds can act through NO-mediated pathways, but delivering pulsed inhaled NO (iNO) directly to the airways and pulmonary vasculature could equally benefit patients. Therefore, a proof-of-concept study was performed to quantify pulmonary blood vessel caliber changes after iNO administration using computed tomography (CT)-based functional respiratory imaging (FRI).

Methods: Six patients with secondary PH due to COPD received "pulsed" iNO in combination with oxygen for 20 minutes via a nasal cannula. Patients underwent a high-resolution CT scan with contrast before and after iNO. Using FRI, changes in volumes of blood vessels and associated lobes were quantified. Oxygen saturation and blood pressure were monitored and patients were asked about their subjective feelings.

Results: Pulmonary blood vessel volume increased by 7.06%±5.37% after iNO. A strong correlation (Ω(2) 0=0.32, P=0.002) was obtained between ventilation and observed vasodilation, suggesting that using the pulsed system, iNO is directed toward the ventilated zones, which consequently experience more vasodilation. Patients did not develop oxygen desaturation, remained normotensive, and perceived an improvement in their dyspnea sensation.

Conclusion: Inhalation of pulsed NO with oxygen causes vasodilation in the pulmonary circulation of COPD patients, mainly in the well-ventilated areas. A high degree of heterogeneity was found in the level of vasodilation. Patients tend to feel better after the treatment. Chronic use trials are warranted.

No MeSH data available.


Related in: MedlinePlus

INOpulse DS-C delivery device and cartridge.Abbreviation: iNO, inhaled nitric oxide.
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f1-copd-11-1533: INOpulse DS-C delivery device and cartridge.Abbreviation: iNO, inhaled nitric oxide.

Mentions: For the indication of COPD-associated PH, inhaled nitrogen oxide (iNO) is being developed as a drug/device combination product to be used with the investigational INOpulse® DS-C delivery device (Bellerophon Therapeutics, Warren, NJ, USA). The investigational INOpulse® DS-C delivery system is made up of a device that uses 0.16 L mini cylinders containing 3.0 mg/L (2,440 ppm) or 6.0 mg/L (4,880 ppm) of NO gas (Figure 1). The device is lightweight, portable, and can be used in an ambulatory setting. The main advantage of the INOpulse DS-C device for spontaneously breathing patients lies in its ability to deliver precise, preset iNO doses over time, independent of the patients’ respiration rate and tidal volume. Prescribed doses of iNO are delivered through INOpulse DS-C device according to the ideal body weight (IBW) per hour (micrograms/kilogram IBW/hour). The iNO dose is pulsed during the beginning of the subject’s inspiration rather than throughout the entire inspiratory period, and the hourly set dose is accurately delivered each hour. Because the amount of drug delivered by the INOpulse DS-C device is independent of the subject’s respiratory frequency and tidal volume, the dose of iNO is tightly controlled.


Pulmonary vascular effects of pulsed inhaled nitric oxide in COPD patients with pulmonary hypertension.

Hajian B, De Backer J, Vos W, Van Holsbeke C, Ferreira F, Quinn DA, Hufkens A, Claes R, De Backer W - Int J Chron Obstruct Pulmon Dis (2016)

INOpulse DS-C delivery device and cartridge.Abbreviation: iNO, inhaled nitric oxide.
© Copyright Policy
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4940019&req=5

f1-copd-11-1533: INOpulse DS-C delivery device and cartridge.Abbreviation: iNO, inhaled nitric oxide.
Mentions: For the indication of COPD-associated PH, inhaled nitrogen oxide (iNO) is being developed as a drug/device combination product to be used with the investigational INOpulse® DS-C delivery device (Bellerophon Therapeutics, Warren, NJ, USA). The investigational INOpulse® DS-C delivery system is made up of a device that uses 0.16 L mini cylinders containing 3.0 mg/L (2,440 ppm) or 6.0 mg/L (4,880 ppm) of NO gas (Figure 1). The device is lightweight, portable, and can be used in an ambulatory setting. The main advantage of the INOpulse DS-C device for spontaneously breathing patients lies in its ability to deliver precise, preset iNO doses over time, independent of the patients’ respiration rate and tidal volume. Prescribed doses of iNO are delivered through INOpulse DS-C device according to the ideal body weight (IBW) per hour (micrograms/kilogram IBW/hour). The iNO dose is pulsed during the beginning of the subject’s inspiration rather than throughout the entire inspiratory period, and the hourly set dose is accurately delivered each hour. Because the amount of drug delivered by the INOpulse DS-C device is independent of the subject’s respiratory frequency and tidal volume, the dose of iNO is tightly controlled.

Bottom Line: Patients did not develop oxygen desaturation, remained normotensive, and perceived an improvement in their dyspnea sensation.A high degree of heterogeneity was found in the level of vasodilation.Patients tend to feel better after the treatment.

View Article: PubMed Central - PubMed

Affiliation: Department of Respiratory Medicine, University Hospital Antwerp, Edegem.

ABSTRACT

Introduction: Severe chronic obstructive pulmonary disease (COPD) is often associated with secondary pulmonary hypertension (PH), which worsens prognosis. PH can be lowered by oxygen, but also by inhaled nitric oxide (NO), which has the potential to improve the health status of these patients. NO is an important mediator in vascular reactions in the pulmonary circulation. Oral compounds can act through NO-mediated pathways, but delivering pulsed inhaled NO (iNO) directly to the airways and pulmonary vasculature could equally benefit patients. Therefore, a proof-of-concept study was performed to quantify pulmonary blood vessel caliber changes after iNO administration using computed tomography (CT)-based functional respiratory imaging (FRI).

Methods: Six patients with secondary PH due to COPD received "pulsed" iNO in combination with oxygen for 20 minutes via a nasal cannula. Patients underwent a high-resolution CT scan with contrast before and after iNO. Using FRI, changes in volumes of blood vessels and associated lobes were quantified. Oxygen saturation and blood pressure were monitored and patients were asked about their subjective feelings.

Results: Pulmonary blood vessel volume increased by 7.06%±5.37% after iNO. A strong correlation (Ω(2) 0=0.32, P=0.002) was obtained between ventilation and observed vasodilation, suggesting that using the pulsed system, iNO is directed toward the ventilated zones, which consequently experience more vasodilation. Patients did not develop oxygen desaturation, remained normotensive, and perceived an improvement in their dyspnea sensation.

Conclusion: Inhalation of pulsed NO with oxygen causes vasodilation in the pulmonary circulation of COPD patients, mainly in the well-ventilated areas. A high degree of heterogeneity was found in the level of vasodilation. Patients tend to feel better after the treatment. Chronic use trials are warranted.

No MeSH data available.


Related in: MedlinePlus