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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

Study protocol.Note: LTOT is represented in L/min.Abbreviations: FRC, functional residual capacity; IBW, ideal body weight; iNO, inhaled nitric oxide; LTOT, long-term oxygen therapy; NO, nitric oxide; TLC, total lung capacity.
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f2-copd-11-1533: Study protocol.Note: LTOT is represented in L/min.Abbreviations: FRC, functional residual capacity; IBW, ideal body weight; iNO, inhaled nitric oxide; LTOT, long-term oxygen therapy; NO, nitric oxide; TLC, total lung capacity.

Mentions: The objective of this exploratory study was to assess the effect of pulsed iNO on vascular geometry in subjects with COPD-related PH who are on LTOT. The primary end point was the change in lobar blood volume at total lung capacity (TLC), measured by functional respiratory imaging (FRI), after dosing with pulsed iNO. Additional end points were internal airflow distribution (to link regional vasodilation with regional ventilation) and patient feeling of dyspnea and exercise tolerance. The study protocol (Figure 2) was approved by the Ethical Committe of the University Hospital of Antwerp, (14/35/361) and informed consent was given by each patient at the time of entry to the study. The clinical trial registration number for this study is NCT02267655.


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)

Study protocol.Note: LTOT is represented in L/min.Abbreviations: FRC, functional residual capacity; IBW, ideal body weight; iNO, inhaled nitric oxide; LTOT, long-term oxygen therapy; NO, nitric oxide; TLC, total lung capacity.
© Copyright Policy
Related In: Results  -  Collection

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

f2-copd-11-1533: Study protocol.Note: LTOT is represented in L/min.Abbreviations: FRC, functional residual capacity; IBW, ideal body weight; iNO, inhaled nitric oxide; LTOT, long-term oxygen therapy; NO, nitric oxide; TLC, total lung capacity.
Mentions: The objective of this exploratory study was to assess the effect of pulsed iNO on vascular geometry in subjects with COPD-related PH who are on LTOT. The primary end point was the change in lobar blood volume at total lung capacity (TLC), measured by functional respiratory imaging (FRI), after dosing with pulsed iNO. Additional end points were internal airflow distribution (to link regional vasodilation with regional ventilation) and patient feeling of dyspnea and exercise tolerance. The study protocol (Figure 2) was approved by the Ethical Committe of the University Hospital of Antwerp, (14/35/361) and informed consent was given by each patient at the time of entry to the study. The clinical trial registration number for this study is NCT02267655.

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