Sildenafil in Pulmonary Hypertension Associated with COPD.

Inhaled nitric oxide improves ventilatory efficiency and exercise capacity in patients with mild COPD: A randomized‐control cross‐over trial

“…Our findings of improved ventilatory efficiency, dyspnoea and exercise capacity with iNO are in contrast to previous work demonstrating that pulmonary vasodilators (iNO or phosphodiesterase-5 inhibitors) do not improve dyspnoea or exercise tolerance in more advanced COPD with and without co-existing pulmonary hypertension (Barbera et al 1996;Roger et al 1997;Ashutosh et al 2000;Rietema et al 2008;Blanco et al 2010;Lederer et al 2012;Blanco et al 2013). With advancing COPD, in addition to vascular dysfunction, there would be further emphysematous destruction of pulmonary capillaries, hypoxic pulmonary vasoconstriction and hypoxaemia.…”

Inhaled nitric oxide improves ventilatory efficiency and exercise capacity in patients with mild COPD: A randomized‐control cross‐over trial

“…Our findings of improved ventilatory efficiency, dyspnoea and exercise capacity with iNO are in contrast to previous work demonstrating that pulmonary vasodilators (iNO or phosphodiesterase-5 inhibitors) do not improve dyspnoea or exercise tolerance in more advanced COPD with and without co-existing pulmonary hypertension (Barbera et al 1996;Roger et al 1997;Ashutosh et al 2000;Rietema et al 2008;Blanco et al 2010;Lederer et al 2012;Blanco et al 2013). With advancing COPD, in addition to vascular dysfunction, there would be further emphysematous destruction of pulmonary capillaries, hypoxic pulmonary vasoconstriction and hypoxaemia.…”

Sexual Dysfunction Among Combat Veterans Injured by Chemical Warfare

“……”

Inhaled therapies targeting prostacyclin pathway in pulmonary hypertension due to COPD: systematic review

“…Despite the improvement of hemodynamic parameters, the use of systemically administered pulmonary vasodilators was associated with a deleterious effect on gas exchange. In patients with COPD, it is thought that systemically administered pulmonary vasodilators (e.g., sildenafil) can dilate vasculature around both ventilated and non-ventilated, leading to inhibition of hypoxic pulmonary vasoconstriction and impairment of gas exchange (42,44). When pulmonary vasodilators, including prostacyclin, are used through the inhalation route in patients with group 3 pulmonary hypertension, the risk of ventilation and perfusion mismatch associated with systemic vasodilators use can be minimised (45), considering that inhaled pulmonary vasodilator use in these patients can target the better-ventilated alveoli.…”

Inhaled nitric oxide improves ventilatory efficiency and exercise capacity in patients with mild COPD: A randomized‐control cross‐over trial

“…Our findings of improved ventilatory efficiency, dyspnoea and exercise capacity with iNO are in contrast to previous work demonstrating that pulmonary vasodilators (iNO or phosphodiesterase-5 inhibitors) do not improve dyspnoea or exercise tolerance in more advanced COPD with and without co-existing pulmonary hypertension (Barbera et al 1996;Roger et al 1997;Ashutosh et al 2000;Rietema et al 2008;Blanco et al 2010;Lederer et al 2012;Blanco et al 2013). With advancing COPD, in addition to vascular dysfunction, there would be further emphysematous destruction of pulmonary capillaries, hypoxic pulmonary vasoconstriction and hypoxaemia.…”

Sexual Dysfunction Among Combat Veterans Injured by Chemical Warfare

“……”

Inhaled therapies targeting prostacyclin pathway in pulmonary hypertension due to COPD: systematic review

“…Despite the improvement of hemodynamic parameters, the use of systemically administered pulmonary vasodilators was associated with a deleterious effect on gas exchange. In patients with COPD, it is thought that systemically administered pulmonary vasodilators (e.g., sildenafil) can dilate vasculature around both ventilated and non-ventilated, leading to inhibition of hypoxic pulmonary vasoconstriction and impairment of gas exchange (42,44). When pulmonary vasodilators, including prostacyclin, are used through the inhalation route in patients with group 3 pulmonary hypertension, the risk of ventilation and perfusion mismatch associated with systemic vasodilators use can be minimised (45), considering that inhaled pulmonary vasodilator use in these patients can target the better-ventilated alveoli.…”

Inhaled nitric oxide improves ventilatory efficiency and exercise capacity in patients with mild COPD: A randomized‐control cross‐over trial

“…Our findings of improved ventilatory efficiency, dyspnoea and exercise capacity with iNO are in contrast to previous work demonstrating that pulmonary vasodilators (iNO or phosphodiesterase-5 inhibitors) do not improve dyspnoea or exercise tolerance in more advanced COPD with and without co-existing pulmonary hypertension (Barbera et al 1996;Roger et al 1997;Ashutosh et al 2000;Rietema et al 2008;Blanco et al 2010;Lederer et al 2012;Blanco et al 2013). With advancing COPD, in addition to vascular dysfunction, there would be further emphysematous destruction of pulmonary capillaries, hypoxic pulmonary vasoconstriction and hypoxaemia.…”

Sexual Dysfunction Among Combat Veterans Injured by Chemical Warfare

“……”

Inhaled therapies targeting prostacyclin pathway in pulmonary hypertension due to COPD: systematic review

“…Despite the improvement of hemodynamic parameters, the use of systemically administered pulmonary vasodilators was associated with a deleterious effect on gas exchange. In patients with COPD, it is thought that systemically administered pulmonary vasodilators (e.g., sildenafil) can dilate vasculature around both ventilated and non-ventilated, leading to inhibition of hypoxic pulmonary vasoconstriction and impairment of gas exchange (42,44). When pulmonary vasodilators, including prostacyclin, are used through the inhalation route in patients with group 3 pulmonary hypertension, the risk of ventilation and perfusion mismatch associated with systemic vasodilators use can be minimised (45), considering that inhaled pulmonary vasodilator use in these patients can target the better-ventilated alveoli.…”