Long-term oxygen therapy (15-18 h/day) reversed pulmonary hypertension progression in severe COPD, changing the yearly pulmonary arterial pressure from a 1.47 mmHg increase to a 2.15 mmHg decrease.
Cohort (n=16)
Does long-term oxygen therapy reverse the progression of pulmonary hypertension in patients with severe COPD?
Long-term oxygen therapy for 15 to 18 hours per day can reverse the progression of pulmonary hypertension in patients with severe COPD, although normalization of pulmonary arterial pressure is rare.
Absolute Event Rate: -2.15% vs 1.47%
p-value: p=<0.05
Sixteen patients with severe chronic obstructive pulmonary disease (COPD) (average values at the onset of O2 therapy: FEV1, 891 +/- 284 ml; PaO2, 50.2 +/- 6.6 mmHg; PaCO2, 51.0 +/- 6.4 mmHg) underwent 3 consecutive right heart catheterizations. The first was performed 47 +/- 28 months (T0) before the onset of long-term O2 therapy (LTO2). The second was performed just before the onset of LTO2 (T1). The third was performed after 31 +/- 19 months of LTO2 (T2). Oxygen therapy (15 to 18 h/day) was prescribed on the basis of usual criteria. From T0 to T1, PaO2 decreased from 59.3 +/- 9.4 to 50.2 +/- 6.6 mmHg, and mean pulmonary arterial pressure (Ppa) worsened from 23.3 +/- 6.8 to 28.0 +/- 7.4 mmHg (p less than 0.005). From T1 to T2, PaO2 was stable, whereas Ppa decreased from 28.0 +/- 7.4 to 23.9 +/- 6.6 mmHg (p less than 0.05). Pulmonary hypertension improved in 12 of the 16 patients. Before the onset of LTO2 (from T0 to T1), there was a yearly increase in Ppa of 1.47 +/- 2.3 mmHg, whereas during LTO2 a yearly decrease of 2.15 +/- 4.4 mmHg was observed, and the difference between these 2 values was highly significant. The changes in Ppa either from T0 to T1 or from T1 to T2 were not associated with concomitant changes in cardiac output or pulmonary capillary wedge pressure but were related to changes in pulmonary vascular resistance. These results suggest that LTO2 for 15 to 18 h/day can reverse the progression of pulmonary hypertension in a high percentage of patients with severe COPD, but that normalization of Ppa is rarely observed.
Weitzenblum et al. (Mon,) realizaram uma coorte em doença pulmonar obstrutiva crônica (DPOC) severa (n=16). A terapia de oxigênio a longo prazo vs. período pré-tratamento foi avaliada na mudança anual na pressão arterial pulmonar média (Ppa) em mmHg (p=<0.05). A terapia de oxigênio a longo prazo (15-18 h/dia) reverteu a progressão da hipertensão pulmonar em DPOC severa, mudando a pressão arterial pulmonar anual de um aumento de 1.47 mmHg para uma diminuição de 2.15 mmHg.