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Inhaled pulmonary vasodilators: a narrative review
Kai Liu1, Huan Wang1, Shen-Ji Yu1
1Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.
Annals of Translational Medicine
|May 14, 2021
Summary
Inhaled pulmonary vasodilators (IPV) offer potential benefits for pulmonary hypertension (PH) but require more research. Current evidence on their safety and efficacy is limited, necessitating further investigation into optimal use and outcomes.
Area of Science:
- Cardiology
- Pulmonology
- Pharmacology
Background:
- Pulmonary hypertension (PH) is a severe condition affecting all ages, often linked to cardiovascular and pulmonary disorders.
- Inhaled pulmonary vasodilators (IPV) are used to reduce pulmonary vascular resistance and improve RV function with minimal systemic effects.
- IPV encompass inhaled nitric oxide (iNO) and aerosolized prostacyclin analogs, with potential benefits beyond vasodilation, including improved oxygenation and reduced inflammation.
Purpose of the Study:
- To review the clinical use and updated evidence of inhaled pulmonary vasodilators (IPV) for pulmonary hypertension (PH).
- To evaluate the safety and efficacy of IPV, addressing the limited and controversial evidence supporting their use.
- To synthesize current literature on IPV, including inhaled nitric oxide (iNO) and other vasodilators.
Main Methods:
- A comprehensive literature search was conducted across PubMed, Google Scholar, EMBASE, and Web of Science.
- Relevant papers published up to May 2020 were included in the review.
- The review focused on the clinical application and evidence base of various IPV.
Main Results:
- Inhaled nitric oxide (iNO) is widely used across pediatric and adult populations for various cardiopulmonary diseases, despite limitations like high cost and rebound PH risk.
- Inhaled aerosolized epoprostenol, iloprost, treprostinil, milrinone, and levosimendan show potential, possibly mirroring iNO's effects.
- Evidence supporting the inhalational administration of these medications remains limited, inconclusive, and controversial regarding safety and efficacy.
Conclusions:
- Further research is essential to establish clear inclusion criteria, long-term outcomes, and optimal management strategies for IPV.
- The review highlights the current clinical landscape and evidence gaps for IPV in managing PH.
- More investigation is needed to determine the ideal time, dose, and duration for IPV administration.
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