CHEST Guidelines-Phosphodiesterase-Inhibitor-Therapy-in-Pulmonary-H

Phosphodiesterase-Inhibitor-Therapy-in-Pulmonary-H

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The article discusses the complexities of using phosphodiesterase inhibitors to treat pulmonary hypertension (PH) associated with chronic obstructive pulmonary disease (COPD). PH is a significant contributor to morbidity and mortality in COPD patients, and a subset has severe PH. Correlations between airflow obstruction and PH severity are inconsistent, and while echocardiograms are useful for initial screening, right heart catheterization is necessary for accurate PH diagnosis. Oxygen therapy remains the primary treatment for PH COPD in hypoxemia, but no FDA-approved drugs currently exist for PH COPD.<br /><br />Clinical trials on pulmonary vasodilators like bosentan, treprostinil, and sildenafil have shown mixed results. Sildenafil, although helpful in reducing certain metrics, has not demonstrated significant improvements in exercise capacity or quality of life in trials. Tadalafil studies also showed no improvements in walk distance or quality of life. Reasons for varied responses may include patient selection and study definitions of PH.<br /><br />Recent data from large registries, including COMPERA and the Pulmonary Vascular Research Institute GoDeep Meta-Registry, indicate that phosphodiesterase inhibitors can extend survival in specific patient subgroups, notably those with a vascular phenotype of PH COPD. These patients are characterized by higher pulmonary vascular resistance (PVR) and less airflow obstruction.<br /><br />The findings highlight the need for better characterization of COPD phenotypes to optimize therapy and suggest the potential role of vasodilators as a bridge to lung transplantation for severe PH patients. Further randomized controlled trials (RCTs) are suggested to confirm the beneficial effects of phosphodiesterase inhibitors in improving survival, exercise capacity, and quality of life for severe PH COPD patients. Overall, the research emphasizes a growing understanding of PH as a distinct vascular phenotype in COPD patients.

Keywords

phosphodiesterase inhibitors

pulmonary hypertension

chronic obstructive pulmonary disease

COPD

right heart catheterization

oxygen therapy

pulmonary vasodilators

sildenafil

tadalafil

vascular phenotype