Pulmonary vascular effects of pulsed inhaled nitric oxide in COPD patients with pulmonary hypertension
Bita Hajian,1 Jan De Backer,2 Wim Vos,2 Cedric Van Holsbeke,2 Francisca Ferreira,2 Deborah A Quinn,3 Annemie Hufkens,1 Rita Claes,1 Wilfried De Backer1 1Department of Respiratory Medicine, University Hospital Antwerp, Edegem, 2FluidDA nv, Antwerp, Belgium; 3Bellerophon Therapeutics, Warren, NJ, USA...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Dove Medical Press
2016-07-01
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| Series: | International Journal of COPD |
| Subjects: | |
| Online Access: | https://www.dovepress.com/pulmonary-vascular-effects-of-pulsed-inhaled-nitric-oxide-in-copd-pati-peer-reviewed-article-COPD |
| _version_ | 1818175382428319744 |
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| author | Hajian B De Backer J Vos W Van Holsbeke C Ferreira F Quinn DA Hufkens A Claes R De Backer W |
| author_facet | Hajian B De Backer J Vos W Van Holsbeke C Ferreira F Quinn DA Hufkens A Claes R De Backer W |
| author_sort | Hajian B |
| collection | DOAJ |
| description | Bita Hajian,1 Jan De Backer,2 Wim Vos,2 Cedric Van Holsbeke,2 Francisca Ferreira,2 Deborah A Quinn,3 Annemie Hufkens,1 Rita Claes,1 Wilfried De Backer1 1Department of Respiratory Medicine, University Hospital Antwerp, Edegem, 2FluidDA nv, Antwerp, Belgium; 3Bellerophon Therapeutics, Warren, NJ, USA 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 (Ω20=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. Keywords: pulmonary hypertension, COPD, pulsed inhaled nitric oxide, FRI |
| first_indexed | 2024-12-11T19:59:24Z |
| format | Article |
| id | doaj.art-dedf65b7e6e94983898240c05d9b577f |
| institution | Directory Open Access Journal |
| issn | 1178-2005 |
| language | English |
| last_indexed | 2024-12-11T19:59:24Z |
| publishDate | 2016-07-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | International Journal of COPD |
| spelling | doaj.art-dedf65b7e6e94983898240c05d9b577f2022-12-22T00:52:34ZengDove Medical PressInternational Journal of COPD1178-20052016-07-012016Issue 11533154127757Pulmonary vascular effects of pulsed inhaled nitric oxide in COPD patients with pulmonary hypertensionHajian BDe Backer JVos WVan Holsbeke CFerreira FQuinn DAHufkens AClaes RDe Backer WBita Hajian,1 Jan De Backer,2 Wim Vos,2 Cedric Van Holsbeke,2 Francisca Ferreira,2 Deborah A Quinn,3 Annemie Hufkens,1 Rita Claes,1 Wilfried De Backer1 1Department of Respiratory Medicine, University Hospital Antwerp, Edegem, 2FluidDA nv, Antwerp, Belgium; 3Bellerophon Therapeutics, Warren, NJ, USA 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 (Ω20=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. Keywords: pulmonary hypertension, COPD, pulsed inhaled nitric oxide, FRIhttps://www.dovepress.com/pulmonary-vascular-effects-of-pulsed-inhaled-nitric-oxide-in-copd-pati-peer-reviewed-article-COPDCOPDpulmonary hypertensionFRIpulsed inhaled nitricoxide |
| spellingShingle | Hajian B De Backer J Vos W Van Holsbeke C Ferreira F Quinn DA Hufkens A Claes R De Backer W Pulmonary vascular effects of pulsed inhaled nitric oxide in COPD patients with pulmonary hypertension International Journal of COPD COPD pulmonary hypertension FRI pulsed inhaled nitricoxide |
| title | Pulmonary vascular effects of pulsed inhaled nitric oxide in COPD patients with pulmonary hypertension |
| title_full | Pulmonary vascular effects of pulsed inhaled nitric oxide in COPD patients with pulmonary hypertension |
| title_fullStr | Pulmonary vascular effects of pulsed inhaled nitric oxide in COPD patients with pulmonary hypertension |
| title_full_unstemmed | Pulmonary vascular effects of pulsed inhaled nitric oxide in COPD patients with pulmonary hypertension |
| title_short | Pulmonary vascular effects of pulsed inhaled nitric oxide in COPD patients with pulmonary hypertension |
| title_sort | pulmonary vascular effects of pulsed inhaled nitric oxide in copd patients with pulmonary hypertension |
| topic | COPD pulmonary hypertension FRI pulsed inhaled nitricoxide |
| url | https://www.dovepress.com/pulmonary-vascular-effects-of-pulsed-inhaled-nitric-oxide-in-copd-pati-peer-reviewed-article-COPD |
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