Limits...
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

Repeatability of two TLC scans and total lung vasodilation (%) and lobar vasodilation (%).Notes: (A) Vasodilation for the total lung: repeatability of the two TLC scans is 1.5%, there is a total increase of 7% in the blood vessel volume using paired t-test (P=0.016). (B) Lobar vasodilation: repeatability of the two TLC scans is 1.5%, there is a total increase of 6.8% of the blood vessel volume using paired t-test (P<0.001). Gray lines: improvement in lobar blood volume; red lines: lobar blood volume remains stable or decreases.Abbreviations: lobar iVbv, image-based blood vessel volume of the lobes; TLC, total lung capacity; total iVbv, image-based blood vessel volume of the total lung.
© Copyright Policy
Related In: Results  -  Collection

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

f5-copd-11-1533: Repeatability of two TLC scans and total lung vasodilation (%) and lobar vasodilation (%).Notes: (A) Vasodilation for the total lung: repeatability of the two TLC scans is 1.5%, there is a total increase of 7% in the blood vessel volume using paired t-test (P=0.016). (B) Lobar vasodilation: repeatability of the two TLC scans is 1.5%, there is a total increase of 6.8% of the blood vessel volume using paired t-test (P<0.001). Gray lines: improvement in lobar blood volume; red lines: lobar blood volume remains stable or decreases.Abbreviations: lobar iVbv, image-based blood vessel volume of the lobes; TLC, total lung capacity; total iVbv, image-based blood vessel volume of the total lung.

Mentions: Figure 5 shows the vascular changes for the total lung and for the individual lobes. In addition, the figure depicts the variability of the FRI measurement (−1.56%±3.57%) relative to the treatment effect (7.06%±5.88%). It can be observed that the variability of the measurement, as determined using the test–retest scenario, is small compared to the iNO treatment effect. There is a significant vasodilation in almost all of the lung lobes.


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)

Repeatability of two TLC scans and total lung vasodilation (%) and lobar vasodilation (%).Notes: (A) Vasodilation for the total lung: repeatability of the two TLC scans is 1.5%, there is a total increase of 7% in the blood vessel volume using paired t-test (P=0.016). (B) Lobar vasodilation: repeatability of the two TLC scans is 1.5%, there is a total increase of 6.8% of the blood vessel volume using paired t-test (P<0.001). Gray lines: improvement in lobar blood volume; red lines: lobar blood volume remains stable or decreases.Abbreviations: lobar iVbv, image-based blood vessel volume of the lobes; TLC, total lung capacity; total iVbv, image-based blood vessel volume of the total lung.
© Copyright Policy
Related In: Results  -  Collection

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

f5-copd-11-1533: Repeatability of two TLC scans and total lung vasodilation (%) and lobar vasodilation (%).Notes: (A) Vasodilation for the total lung: repeatability of the two TLC scans is 1.5%, there is a total increase of 7% in the blood vessel volume using paired t-test (P=0.016). (B) Lobar vasodilation: repeatability of the two TLC scans is 1.5%, there is a total increase of 6.8% of the blood vessel volume using paired t-test (P<0.001). Gray lines: improvement in lobar blood volume; red lines: lobar blood volume remains stable or decreases.Abbreviations: lobar iVbv, image-based blood vessel volume of the lobes; TLC, total lung capacity; total iVbv, image-based blood vessel volume of the total lung.
Mentions: Figure 5 shows the vascular changes for the total lung and for the individual lobes. In addition, the figure depicts the variability of the FRI measurement (−1.56%±3.57%) relative to the treatment effect (7.06%±5.88%). It can be observed that the variability of the measurement, as determined using the test–retest scenario, is small compared to the iNO treatment effect. There is a significant vasodilation in almost all of the lung lobes.

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