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Sildenafil improves hemodynamic parameters in COPD-an investigation of six patients.

Alp S, Skrygan M, Schmidt WE, Bastian A

Department of Internal Medicine 1, St. Josef Hospital, University Hospital of the Ruhr-Universität Bochum, Germany.

Pulmonary hypertension (PH) is an important predictor of mortality in chronic obstructive pulmonary disease (COPD). The phosphodiesterase 5 inhibitor sildenafil has been demonstrated to reduce pulmonary arterial pressure (PAP) in different diseases. We wanted to investigate the effect of sildenafil on hemodynamic parameters and the 6-min walk test (6MWT) in six patients with severe COPD and echocardiographically estimated PH. A 6MWT was performed and hemodynamic parameters were measured by right heart catheterization before and 1 and 12h after injection of 50mg sildenafil intravenously. A 3-months period of peroral sildenafil therapy 50mg twice daily followed and finally hemodynamic parameters and a 6MWT were repeated. Intravenously applied sildenafil could be demonstrated to reduce PAP and pulmonary vasculature resistance (PVR) significantly. And after 3 months of oral sildenafil, the mean PAP has decreased from 30.2+/-5.5mmHg (range: 24-39mmHg) to 24.6+/-4.2mmHg (range: 20-30mmHg) (p=0.01). The PVR has decreased from 401+/-108dynscm(-5) (range: 266-558dynscm(-5)) to 264+/-52dynscm(-5) (range: 204-333dynscm(-5)) (p<0.05). Physical conditions improved: the 6-min walk distance increased from 351+/-49 to 433+/-52m. In conclusion, in six patients suffering from severe COPD we could demonstrate significantly improved hemodynamic parameters after 50mg sildenafil intravenous application. And after 3 months of oral sildenafil, walking distance in the 6MWT increased significantly as well as hemodynamic parameters in the five patients who had accepted a second right heart catheterization.

Published 17 November 2005 in Pulm Pharmacol Ther.
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