CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Controlled prospective randomised trial on the effects on pulmonary haemodynamics of the ambulatory long term use of nitric oxide and oxygen in patients with severe COPD

K Vonbank¹, R Ziesche¹, T W Higenbottam³, L Stiebellehner¹, V Petkov¹, P Schenk¹, P Germann², L H Block¹

¹ Vienna Medical School, Department of Internal Medicine IV, Clinical Division of Pulmonary Medicine, A-1090 Vienna, Austria
² Vienna Medical School, Department of Anesthesiology, A-1090 Vienna, Austria
³ University of Sheffield Medical School, Division of Clinical Sciences, Section of Respiratory Medicine, Sheffield S10 2RX, UK

Correspondence to:
Correspondence to:
Professor L H Block, University of Vienna Medical School, Department of Internal Medicine IV, Clinical Division of Pulmonary Medicine, Währinger Gürtel 18–20, 1090 Vienna, Austria;
lutz-henning.block{at}akh-wien.ac.at

Background: Pulmonary hypertension is a frequent complication of severe chronic obstructive pulmonary disease (COPD) and a major cause of morbidity and mortality in this condition. Based on the improved survival of these patients due to long term oxygen therapy and the potent and selective pulmonary vasodilation by inhaled nitric oxide, the safety and effectiveness of the combined inhalation of these two gases over a 3 month period was assessed.

Methods: Forty patients with secondary pulmonary hypertension due to COPD were randomly assigned to receive either oxygen alone or "pulsed" inhalation of nitric oxide with oxygen over a period of 3 months. "Pulsed" inhalation of nitric oxide was used to reduce pulmonary ventilation-perfusion mismatch and formation of toxic reaction products of nitric oxide and oxygen.

Results: Compared with oxygen alone, the combined inhalation of nitric oxide and oxygen caused a significant decrease in mean (SE) pulmonary artery pressure (from 27.6 (4.4) mm Hg to 20.6 (4.9) mm Hg, p<0.001) and pulmonary vascular resistance index (from 569.7 (208.1) to 351.3 (159.9) dyne•s^-1•cm^-5•m^-2, p<0.001) without decreasing arterial oxygenation. Cardiac output increased by 0.5 litres (from 5.6 (1.3) l/min to 6.1 (1.0) l/min, p=0.025). Systemic haemodynamics and left heart function remained unchanged during this period and no increase in toxic reaction products of nitric oxide was observed.

Conclusions: This is the first controlled trial indicating that the "pulsed" inhalation of nitric oxide together with oxygen may be safely and effectively used for the long term treatment of severe COPD.

Keywords: chronic obstructive pulmonary disease; pulmonary hypertension; nitric oxide; oxygen

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

Relevant Article

Airwaves

Wisia Wedzicha
Thorax 2003 58: 283. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

• Weitzenblum, E, Chaouat, A (2009). Cor pulmonale. Chronic Respiratory Disease 6: 177-185 [Abstract]  
• Chaouat, A., Naeije, R., Weitzenblum, E. (2008). Pulmonary hypertension in COPD. Eur Respir J 32: 1371-1385 [Abstract] [Full Text]  
• Stolz, D., Rasch, H., Linka, A., Di Valentino, M., Meyer, A., Brutsche, M., Tamm, M. (2008). A randomised, controlled trial of bosentan in severe COPD. Eur Respir J 32: 619-628 [Abstract] [Full Text]  
• Falk, J. A., Kadiev, S., Criner, G. J., Scharf, S. M., Minai, O. A., Diaz, P. (2008). Cardiac Disease in Chronic Obstructive Pulmonary Disease. Proc Am Thorac Soc 5: 543-548 [Abstract] [Full Text]  
• Fisher, M. R., Criner, G. J., Fishman, A. P., Hassoun, P. M., Minai, O. A., Scharf, S. M., Fessler, a. H. E., for the National Emphysema Treatment Trial (NETT), (2007). Estimating pulmonary artery pressures by echocardiography in patients with emphysema. Eur Respir J 30: 914-921 [Abstract] [Full Text]  
• Falk, J. A., Martin, U. J., Scharf, S., Criner, G. J. (2007). Lung Elastic Recoil Does Not Correlate With Pulmonary Hemodynamics in Severe Emphysema. Chest 132: 1476-1484 [Abstract] [Full Text]  
• Bloch, K. D., Ichinose, F., Roberts, J. D. Jr., Zapol, W. M. (2007). Inhaled NO as a therapeutic agent. Cardiovasc Res 75: 339-348 [Abstract] [Full Text]  
• Griffiths, M. J.D., Evans, T. W. (2005). Inhaled Nitric Oxide Therapy in Adults. NEJM 353: 2683-2695 [Full Text]  
• Barnes, P. J., Stockley, R. A. (2005). COPD: current therapeutic interventions and future approaches. Eur Respir J 25: 1084-1106 [Abstract] [Full Text]  
• Higenbottam, T. (2005). Pulmonary Hypertension and Chronic Obstructive Pulmonary Disease: A Case for Treatment. Proc Am Thorac Soc 2: 12-19 [Abstract] [Full Text]  
• Chicoine, L. G., Tzeng, E., Bryan, R., Saenz, S., Paffett, M. L., Jones, J., Lyons, C. R., Resta, T. C., Nelin, L. D., Walker, B. R. (2004). Intratracheal adenoviral-mediated delivery of iNOS decreases pulmonary vasoconstrictor responses in rats. J. Appl. Physiol. 97: 1814-1822 [Abstract] [Full Text]  
• Ricciardolo, F. L. M., Sterk, P. J., Gaston, B., Folkerts, G. (2004). Nitric Oxide in Health and Disease of the Respiratory System. Physiol. Rev. 84: 731-765 [Abstract] [Full Text]  
• Ichinose, F., Roberts, J. D. Jr, Zapol, W. M. (2004). Inhaled Nitric Oxide: A Selective Pulmonary Vasodilator: Current Uses and Therapeutic Potential. Circulation 109: 3106-3111 [Full Text]  
• Adhikari, N., Granton, J. T. (2004). Inhaled Nitric Oxide for Acute Lung Injury: No Place for NO?. JAMA 291: 1629-1631 [Full Text]  
• Pepke-Zaba, J, Morrell, N W (2003). Pulmonary hypertension in patients with COPD: NO treatment?. Thorax 58: 283-284 [Full Text]