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Department of
Medicine, Pulmonary Disease and Cardiology Section, Veterans Affairs
Medical Center and SUNY Upstate Health Science Center, Syracuse, New
York 13210, USA
Correspondence to: Dr K Ashutosh
Received 1 February 1999; Returned to authors 19 April 1999; Revised version received 26 October 1999; Accepted for publication 27 October 1999
BACKGROUND
Inhalation
of nitric oxide with oxygen could be a promising treatment in patients
with chronic obstructive pulmonary disease (COPD) and pulmonary
hypertension. However, the current methods of delivery of NO are
cumbersome and unsuitable for long term use. The present study was
undertaken to investigate the safety and efficacy of a mixture of
nitric oxide (NO) and oxygen administered via a nasal cannula for 24 hours in patients with oxygen dependent COPD.
METHODSTwenty five
parts per million (ppm) of NO was administered by inhalation combined
with supplemental oxygen at a flow rate of 2 l/min via a nasal cannula
for 24 hours to 11 ambulatory men with stable, oxygen dependent COPD.
Room air with supplemental oxygen at 2 l/min was administered in an
identical manner for another 24 hours as control therapy in a
randomised, double blind, crossover fashion to all patients. Pulmonary
function tests, exercise tolerance, dyspnoea grade, and lung volumes
were measured at baseline, 24, and 48 hours. Pulmonary artery pressure
(PAP), cardiac output (CO), pulmonary vascular resistance (PVR),
arterial blood gas tensions, and minute ventilation were measured at
baseline, after 30 minutes and 24 hours of breathing NO and oxygen.
Venous admixture ratio (Qs/Qt) and dead space ratio (Vd/Vt) were also
calculated. Concentrations of nitrogen dioxide (NO2) and NO
in the inhaled and ambient air were monitored continuously. Differences
in pulmonary function, arterial blood gas tensions, pulmonary
haemodynamics, exercise tolerance, and dyspnoea between oxygen and NO
breathing periods were analysed for significance using paired
t tests.
RESULTSA significant
(p<0.05) fall was observed in PVR (183.1 (116.05) and 137.2 (108.4) dynes.s.cm-3 before and after breathing NO for 24 hours, respectively) with NO administration without significant changes
in symptoms, pulmonary function, arterial oxygen tension, or exercise tolerance.
CONCLUSIONSNO at a
concentration of 25 ppm blended with oxygen can be safely administered
by nasal cannula for 24 hours without significant adverse effects and
lowers PVR in stable patients with COPD receiving long term oxygen therapy.
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