Pulmonary Hypertension(PH) associated to Chronic Obstructive Pulmonary Disease (COPD) III-IV GOLD stage is well-known related to hypoxemia. Pulmonary vascular remodelling (PVR), with organic changes of vessels, is frequently present.It is well demonstrated that Endothelin plays a important role on the pathogenesis of PVR and PH.
Our aim was to assess the effect of endothelin receptor antagonist, Bosentan,125 mg b.i.d., administered to 16 patients affected by PH and COPD for 18 months, on the progressive worsening of PVR and PH. Pulmonary function test, echo-cardiac-doppler, cardio-pulmonary TC with retrospective gating, rigth heart catheterization,effort performance(6MWT), blood gas analysis and quality of life were performed at the beginning and at the end of the study. Median pulmonary artery pressure (PAP) like or more of 25mmHg at rest was considered significant Control group was 16 patients with overlapping cinical features.
30 percent of patients showed significant improvement of PH, PVR, effort performance.The patients in which vascular remodelling was well established, did not showed improvement but, at the same time, did not showed worsening of parameters cited above.
In all patients, the regular treatment with Bosentan 125 mg b.i.d., can antagonize the progressive worsening of PVR and PH. Futhermore, we obtained improvement of 6MWT, cariovascular performance, dyspnoea, prognosis.
It should be useful early treatment of patients affected by PH and COPD III-IV GOLD stage, before pathologic vessels changes taken place.
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