The safety and tolerability of inhaled treprostinil in patients with pulmonary hypertension and chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease-associated pulmonary hypertension (COPD-PH) is an increasingly recognised condition which contributes to worsening dyspnea and poor survival in COPD. It is uncertain whether specific treatment of COPD-PH, including use of medications approved for pulmonary arterial hypertension (PAH), improves clinical outcomes. This systematic review and meta-analysis assesses potential benefits and risks of therapeutic options COPD-PH.We searched Medline and Embase for relevant publications until Sep 2020. Articles were screened for studies on treatment of COPD-PH for at least 4 weeks in 10 or more patients. Screening, data extraction, and risk of bias assessment were performed independently in duplicate. When possible, relevant results were pooled using the random effects model.Supplemental long-term O2 therapy (LTOT) mildly reduced mean pulmonary artery pressure (PAP), slowed progression of PH, and reduced mortality, but other clinical or functional benefits were not assessed. Phosphodiesterase type-5 inhibitors significantly improved systolic PAP (pooled treatment effect −5.9 mmHg; 95%CI −10.3, −1.6), but had inconsistent clinical benefits. Calcium-channel blockers and endothelin receptor antagonists had limited hemodynamic, clinical, or survival benefits. Statins had limited clinical benefits despite significantly lowering systolic PAP (pooled treatment effect −4.6 mmHg; 95% CI: −6.3, −2.9).This review supports guideline recommendations for LTOT in hypoxemic COPD-PH patients as well as recommendations against treatment with PAH-targeted medications, Effective treatment of COPD-PH depends upon research into the pathobiology, and future high-quality studies comprehensively assessing clinically relevant outcomes are needed.

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EVALUATION OF PULMONARY HYPERTENSION IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE

International Journal of Integrative Medical Sciences ◽

10.16965/ijims.2019.102 ◽

2019 ◽

Vol 6 (1) ◽

pp. 765-768

Author(s):

G. Peter Praveen Herald ◽

◽

H Krishna Murthy ◽

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Pulmonary Hypertension ◽

Pulmonary Disease ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease

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Statins for the Treatment of Pulmonary Hypertension in Patients with Chronic Obstructive Pulmonary Disease

Frontiers in Pharmacology ◽

10.3389/fphar.2020.613761 ◽

2021 ◽

Vol 11 ◽

Author(s):

Chung-Yu Chen ◽

Wen-Ting Wu ◽

Ya-Ling Wang ◽

Kuang-Ming Liao

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Pulmonary Hypertension ◽

Pulmonary Disease ◽

Chronic Obstructive ◽

Statin User ◽

User Group ◽

Population Database ◽

Obstructive Pulmonary Disease ◽

Copd Patients ◽

One Year

Background: Patients with chronic obstructive pulmonary disease (COPD) are at risk for pulmonary hypertension (PH). The aim of our study was to investigate the benefit of statins for PH in patients with COPD.Methods: The study enrolled 23 million individuals from Taiwan’s population database from January 1, 2002, to December 31, 2017. COPD patients who met the inclusion criteria were enrolled, and patients with lung cancer, less than one year of observation, specific drug therapy for PH and lung transplantation were excluded.Results: A total of 643,131 COPD patients were included in the study, and only 12,308 patients developed PH during follow-up. Based on the inclusion and exclusion criteria, 8,577 PH patients were included in the cohort of patients with PH related to COPD for analysis. According to the definition of statin exposure, the final study population had 1,487 statin users and 7,090 statin non-users. The statin user group had a lower mortality related to PH than the non-user group (3.87 vs. 5.55 per 100 person-years, p < 0.001). The mortality rate for PH in the multivariate analysis (aHR = 0.78, 95% CI = 0.62–0.98, p = 0.046) was significantly lower for statin users than for non-users.Conclusion: Statins seem to benefit patients with PH and COPD.

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