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Long-term treatment of pulmonary hypertension with aerosolized iloprost

Dept of ¹ Cardiology, ² Dept of Pulmonary Medicine, ³ Dept of Medical Statistics and ⁴ Dept of Intensive Care Medicine, University of Vienna

CORRESPONDENCE: I.M. Lang, Dept of Internal Medicine II, Division of Cardiology, University of Vienna, Austria. Fax: 1 4314081148

Keywords: chronic vasodilator therapy, ilomedin, pulmonary hypertension

Received: May 10, 2000
Accepted August 2, 2000

This research was supported in part by Austrian fellowship grants FWFP 10559-MED and P13834-MED (to IML), and by the Ludwig Boltswann Institute for Cardiovascular Research.

Pulmonary arterial hypertension (PAH), defined as elevated pulmonary arterial pressure and pulmonary vascular resistance, is an end-point of a variety of conditions. The only therapy that has been shown to improve both quality of life and survival is intravenous prostacyclin (prostaglandin I₂ (PGI₂), epoprostenol).

The effect of long-term aerosolized iloprost (Ilomedin, Schering, Berlin, Germany and Vienna, Austria), a stable prostacyclin analogue and potent vasodilator, on haemodynamics and functional status was investigated in 12 patients with severe pulmonary hypertension. Haemodynamic measurements and vasodilator testing by right heart catheterization were performed prior to and after long-term iloprost inhalation therapy.

Haemodynamic improvement or increased exercise tolerance was not observed in any of the patients. After a mean±sd treatment period of 10±5 months, mean±sd pulmonary vascular resistance had increased from 11±3 Wood Units (mmHg·L^–1·min) to 13±4 Wood Units, with unchanged arterial oxygen saturation (92±4% versus 91±4%). Within the study period, three patients went into right heart failure and had to be placed on intravenous epoprostenol.

The authors conclude that inhaled iloprost in addition to conventional therapy in the presently recommended dose of 100 µg·day^–1 delivered in 8–10 2 h portions, is not an efficient vasodilator therapy in severe pulmonary hypertension. It remains to be shown whether dose increases and/or combination protocols will be effective, or whether inhalation of iloprost may be safe for selected cases of pulmonary hypertension.

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