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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

The SpO2 did not decrease after iNO.Abbreviations: iNO, inhaled nitric oxide; SpO2, oxygen partial pressure.
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f7-copd-11-1533: The SpO2 did not decrease after iNO.Abbreviations: iNO, inhaled nitric oxide; SpO2, oxygen partial pressure.

Mentions: The changes in the volume of the blood vessels correlate well with regional ventilation, also derived from the functional CT based on lobe expansion. Vasodilation occurs in areas that are well ventilated. Because of this, we can anticipate that the ventilation perfusion ratio is preserved (Figure 6). There was no decrease in the oxygen saturation (Figure 7), which confirms the fact that the vasodilation is in line with the ventilation. Therefore, this presumably reflects a preserved ventilation perfusion ratio. The patients improved in their subjective feelings of dyspnea and exercise tolerance 24 hours after treatment (Figure 8).


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)

The SpO2 did not decrease after iNO.Abbreviations: iNO, inhaled nitric oxide; SpO2, oxygen partial pressure.
© Copyright Policy
Related In: Results  -  Collection

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

f7-copd-11-1533: The SpO2 did not decrease after iNO.Abbreviations: iNO, inhaled nitric oxide; SpO2, oxygen partial pressure.
Mentions: The changes in the volume of the blood vessels correlate well with regional ventilation, also derived from the functional CT based on lobe expansion. Vasodilation occurs in areas that are well ventilated. Because of this, we can anticipate that the ventilation perfusion ratio is preserved (Figure 6). There was no decrease in the oxygen saturation (Figure 7), which confirms the fact that the vasodilation is in line with the ventilation. Therefore, this presumably reflects a preserved ventilation perfusion ratio. The patients improved in their subjective feelings of dyspnea and exercise tolerance 24 hours after treatment (Figure 8).

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