PURPOSE: Pulmonary Hypertension(PH) is associated to advanced COPD in 20% to 40% of patients. PH contributes to a greater amount of exercise limitation even in presence of dynamic hyperinflation. Because Idiopathic pulmonary hypertension and COPD pulmonary hypertension share a common vascular intimal tickening, excess endothelin receptor expression and excess of endothelin 1, our aim is to demonstrate whether oral endothelin-1 antagonist, eg Bosentan, can also improve PH, Excercise tolerance and PFT score in patients affected by severe COPD and PH.
METHODS: We studied 20 patients affected by COPD moderate to severe and PH suspected, initially, by symptoms, by the shape of pulmonary artery on chest radiograph , by ECG and Cardiac-Echo-Doppler and confirmed by Right Side Catheterization.All patients were submitted to whole body pletismograph, to blood gas analysis, to six minutes walking test(6MWT) at baseline and after three, six and twelve months of administration of Bosentan 125 mg bid. Right Side Catheterization was performed at baseline and after 1 year of treatment. Control group were 20 patients affected by COPD but without PH.
RESULTS: 12/20 patients showed, after 1 year of treatment, an improvement of respiratory functional parameters and increase of 6MWT from baseline with improvement of Borg Scale's score. Five patients were not responder to treatment; three patients dropped out the study.
CONCLUSION: The regular assumption of Bosentan 125mg bid in patients affected by COPD+PH, showed efficacy on improvement of 6MWT and on the PFT score with no significant collateral effect. These reflect, most likely, anti vasospastic, anti bronchospastic, anti secretive and anti mithogenic effects, formerly proved, of this drug.
CLINICAL IMPLICATIONS: It would be attractive to investigate about the impact of the therapy on the inevitable clinical worsening of PH along the natural hysory of disesae and to verify if it is able to determine a favourable impact on morbidity and mortality. Further, long-term, clinical studies will be necessary to understand these ecouraging suppositiion.
DISCLOSURE: Pietro Bracciale, None.