Cargando…

Clinical perspectives with long-term pulsed inhaled nitric oxide for the treatment of pulmonary arterial hypertension

Pulmonary arterial hypertension (PAH) is a chronic, progressive disease of the pulmonary vasculature with a high morbidity and mortality. Its pathobiology involves at least three interacting pathways – prostacyclin (PGI(2)), endothelin, and nitric oxide (NO). Current treatments target these three pa...

Descripción completa

Detalles Bibliográficos
Autores principales: Barst, Robyn J., Channick, Richard, Ivy, Dunbar, Goldstein, Brahm
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Medknow Publications & Media Pvt Ltd 2012
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3401867/
https://www.ncbi.nlm.nih.gov/pubmed/22837854
http://dx.doi.org/10.4103/2045-8932.97589
_version_ 1782238673523179520
author Barst, Robyn J.
Channick, Richard
Ivy, Dunbar
Goldstein, Brahm
author_facet Barst, Robyn J.
Channick, Richard
Ivy, Dunbar
Goldstein, Brahm
author_sort Barst, Robyn J.
collection PubMed
description Pulmonary arterial hypertension (PAH) is a chronic, progressive disease of the pulmonary vasculature with a high morbidity and mortality. Its pathobiology involves at least three interacting pathways – prostacyclin (PGI(2)), endothelin, and nitric oxide (NO). Current treatments target these three pathways utilizing PGI(2) and its analogs, endothelin receptor antagonists, and phosphodiesterase type-5 (PDE-5) inhibitors. Inhaled nitric oxide (iNO) is approved for the treatment of hypoxic respiratory failure associated with pulmonary hypertension in term/near-term neonates. As a selective pulmonary vasodilator, iNO can acutely decrease pulmonary artery pressure and pulmonary vascular resistance without affecting cardiac index or systemic vascular resistance. In addition to delivery via the endotracheal tube, iNO can also be administered as continuous inhalation via a facemask or a pulsed nasal delivery. Consistent with a deficiency in endogenously produced NO, long-term pulsed iNO dosing appears to favorably affect hemodynamics in PAH patients, observations that appear to correlate with benefit in uncontrolled settings. Clinical studies and case reports involving patients receiving long-term continuous pulsed iNO have shown minimal risk in terms of adverse events, changes in methemoglobin levels, and detectable exhaled or ambient NO or NO(2). Advances in gas delivery technology and strategies to optimize iNO dosing may enable broad-scale application to long-term treatment of chronic diseases such as PAH.
format Online
Article
Text
id pubmed-3401867
institution National Center for Biotechnology Information
language English
publishDate 2012
publisher Medknow Publications & Media Pvt Ltd
record_format MEDLINE/PubMed
spelling pubmed-34018672012-07-26 Clinical perspectives with long-term pulsed inhaled nitric oxide for the treatment of pulmonary arterial hypertension Barst, Robyn J. Channick, Richard Ivy, Dunbar Goldstein, Brahm Pulm Circ Review Article Pulmonary arterial hypertension (PAH) is a chronic, progressive disease of the pulmonary vasculature with a high morbidity and mortality. Its pathobiology involves at least three interacting pathways – prostacyclin (PGI(2)), endothelin, and nitric oxide (NO). Current treatments target these three pathways utilizing PGI(2) and its analogs, endothelin receptor antagonists, and phosphodiesterase type-5 (PDE-5) inhibitors. Inhaled nitric oxide (iNO) is approved for the treatment of hypoxic respiratory failure associated with pulmonary hypertension in term/near-term neonates. As a selective pulmonary vasodilator, iNO can acutely decrease pulmonary artery pressure and pulmonary vascular resistance without affecting cardiac index or systemic vascular resistance. In addition to delivery via the endotracheal tube, iNO can also be administered as continuous inhalation via a facemask or a pulsed nasal delivery. Consistent with a deficiency in endogenously produced NO, long-term pulsed iNO dosing appears to favorably affect hemodynamics in PAH patients, observations that appear to correlate with benefit in uncontrolled settings. Clinical studies and case reports involving patients receiving long-term continuous pulsed iNO have shown minimal risk in terms of adverse events, changes in methemoglobin levels, and detectable exhaled or ambient NO or NO(2). Advances in gas delivery technology and strategies to optimize iNO dosing may enable broad-scale application to long-term treatment of chronic diseases such as PAH. Medknow Publications & Media Pvt Ltd 2012 /pmc/articles/PMC3401867/ /pubmed/22837854 http://dx.doi.org/10.4103/2045-8932.97589 Text en Copyright: © Pulmonary Circulation http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Review Article
Barst, Robyn J.
Channick, Richard
Ivy, Dunbar
Goldstein, Brahm
Clinical perspectives with long-term pulsed inhaled nitric oxide for the treatment of pulmonary arterial hypertension
title Clinical perspectives with long-term pulsed inhaled nitric oxide for the treatment of pulmonary arterial hypertension
title_full Clinical perspectives with long-term pulsed inhaled nitric oxide for the treatment of pulmonary arterial hypertension
title_fullStr Clinical perspectives with long-term pulsed inhaled nitric oxide for the treatment of pulmonary arterial hypertension
title_full_unstemmed Clinical perspectives with long-term pulsed inhaled nitric oxide for the treatment of pulmonary arterial hypertension
title_short Clinical perspectives with long-term pulsed inhaled nitric oxide for the treatment of pulmonary arterial hypertension
title_sort clinical perspectives with long-term pulsed inhaled nitric oxide for the treatment of pulmonary arterial hypertension
topic Review Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3401867/
https://www.ncbi.nlm.nih.gov/pubmed/22837854
http://dx.doi.org/10.4103/2045-8932.97589
work_keys_str_mv AT barstrobynj clinicalperspectiveswithlongtermpulsedinhalednitricoxideforthetreatmentofpulmonaryarterialhypertension
AT channickrichard clinicalperspectiveswithlongtermpulsedinhalednitricoxideforthetreatmentofpulmonaryarterialhypertension
AT ivydunbar clinicalperspectiveswithlongtermpulsedinhalednitricoxideforthetreatmentofpulmonaryarterialhypertension
AT goldsteinbrahm clinicalperspectiveswithlongtermpulsedinhalednitricoxideforthetreatmentofpulmonaryarterialhypertension