Pulmonary Vascular Disease |

Treatment of Pulmonary Hypertension in COPD: Implications for Exercise Tolerance and Mortality FREE TO VIEW

Russell Buhr, MD; Oksana Shlobin, MD; A. Whitney Brown, MD; Shahzad Ahmad, MD; Nargues Weir, MD; Steven Nathan, MD
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Department of Internal Medicine, MedStar Georgetown University Hospitall, Washington, DC

Chest. 2013;144(4_MeetingAbstracts):853A. doi:10.1378/chest.1700261
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SESSION TITLE: DVT/PE/Pulmonary Hypertension Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: Patients with advanced COPD may develop pulmonary hypertension (PH) which is associated with significant morbidity and mortality. The role, if any, of pulmonary vasoactive therapies in PH due to COPD remains unknown. The goal of our retrospective analysis was to evaluate the outcomes of patients with severe COPD who were treated with PH-specific therapies.

METHODS: COPD patients with right heart catheterization proven PH were identified. The subgroup of patients treated with PH-specific medications were matched to those who were untreated. A comparison was performed between the baseline (pre-treatment) 6MWT distance and follow-up 6MWT distance in the treated group. A Kaplan-Meier survival analysis was performed and compared in the treated and untreated groups.

RESULTS: There were 18 COPD-PH patients treated with PH-specific therapies who were matched to 18 untreated COPD-PH patients. Baseline characteristics of the two cohorts were not significantly different except mean PA pressure (43.1 vs. 33.7, p=0.0075) and PVR (7 vs. 2.5 Wood units, p=0.0007), which were higher in the treatment group. 6MWD did not change significantly with treatment (mean increase 10.9 meters, p=0.2654). The cohort was categorized into 3 subgroups based on change in 6MWD but there was no significant differences in patient characteristics, CT-scan phenotype, or treatment modalities between the groups. There was no difference in mortality between untreated and treated patients (median 38 vs. 37 months, hazard ratio 0.83, p = 0.6346).

CONCLUSIONS: Treatment of PH-related to COPD with pulmonary vasoactive agents did not appear to impact exercise tolerance or mortality in our small cohort of patients with severe COPD. There were select cases with marked improvement in their walk distances, however no unifying characteristics were identified as predictors of success.

CLINICAL IMPLICATIONS: There was no evidence of harm with the use of vasoactive agents and our results should not preclude, but should rather serve to encourage future large randomized controlled studies of PH-specific therapies in COPD.

DISCLOSURE: Oksana Shlobin: Consultant fee, speaker bureau, advisory committee, etc.: Speaker for United Therapeutics and Actelion Pharmaceuticals Steven Nathan: Grant monies (from industry related sources): research funding, consultant, speakers bureau for Gilead, United Therapeutics and Actelion, Consultant fee, speaker bureau, advisory committee, etc.: research funding, consultant, speakers bureau for Gilead, United Therapeutics and Actelion The following authors have nothing to disclose: Russell Buhr, A. Whitney Brown, Shahzad Ahmad, Nargues Weir

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