J Korean Med Sci.  2013 Aug;28(8):1200-1206. 10.3346/jkms.2013.28.8.1200.

Systematic Review and Meta-Analysis of Pulmonary Hypertension Specific Therapy for Exercise Capacity in Chronic Obstructive Pulmonary Disease

• Park J
• Song JH
• Park DA
• Lee JS
• Lee SD
• Oh YM

• KMID: 1793026
• DOI: http://doi.org/10.3346/jkms.2013.28.8.1200

Abstract

Some patients with chronic obstructive pulmonary disease (COPD) have pulmonary hypertension (PH) that adversely affects survival. We performed a systematic review and meta-analysis to assess whether PH-specific therapies have an effect for stable COPD. Data sources were Medline, EMBASE, Cochrane Central Register of Controlled Trials, Korea med and references from relevant publications. Randomized prospective trials that compared PH specific therapy in COPD for more than 6 weeks with placebo were included. The outcomes were the exercise capacity and adverse events. Four randomized controlled trials involving 109 subjects were included in the analysis. Two trials involved bosentan, one sildenafil and one beraprost. The studies varied in duration of treatment from 3 to 18 months. In a pooled analysis of four trials, exercise-capacity was not significantly improved with PH-specific treatment for COPD (risk ratio, -5.1; 95% CI, -13.0 to 2.8). COPD with overt PH significantly improved the exercise capacity (mean difference, 111.6; 95% CI, 63.3 to 159.9) but COPD with PH unknown did not (mean difference, 26.6; 95% CI, -24.3 to 77.5). There was no significant difference in hypoxemia (mean difference, 2.6; 95% CI, -3.7 to 8.8). PH specific treatments have a significant effect in improving exercise capacity in COPD with overt PH.

Keyword

COPD; Pulmonary Hypertension; Vasodilator; Exercise

MeSH Terms

Anoxia
Antihypertensive Agents/adverse effects/*therapeutic use
Clinical Trials as Topic
Databases, Factual
Epoprostenol/adverse effects/analogs & derivatives/therapeutic use
Humans
Hypertension, Pulmonary/complications/*drug therapy
Piperazines/adverse effects/therapeutic use
Pulmonary Disease, Chronic Obstructive/*etiology
Purines/adverse effects/therapeutic use
Questionnaires
Risk Factors
Sulfonamides/adverse effects/therapeutic use
Sulfones/adverse effects/therapeutic use
Antihypertensive Agents
Epoprostenol
Piperazines
Purines
Sulfonamides
Sulfones

Figure

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  Fig. 1 Flow chart of study selection. (A) randomized controlled studies, (B) observational studies.

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  Fig. 2 Risk of bias assessment for the randomized controlled studies included in the meta-analysis.

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  Fig. 3 Meta-analysis of randomized controlled studies of pulmonary hypertension specific treatment for COPD. SD, standard difference; IV, inverse variance; CI, confidence interval; df, degree of freedom.

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  Fig. 4 Meta-analysis of randomized controlled studies about pulmonary hypertension specific treatment for COPD. SD, standard difference; IV, inverse variance; CI, confidence interval; df, degree of freedom.

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  Fig. 5 Meta-analysis of hypoxemia after pulmonary hypertension specific treatment in chronic obstructive pulmonary disease in the randomized controlled studies. SD, standard difference; IV, inverse variance; CI, confidence interval; df, degree of freedom.

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  Fig. 6 Meta-analysis of observational studies about pulmonary hypertension specific treatment for COPD. SD, standard difference; IV, inverse variance; CI, confidence interval; df, degree of freedom.

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  Fig. 7 Meta-analysis of hypoxemia after pulmonary hypertension specific treatment in chronic obstructive pulmonary disease in the observational studies. SD, standard difference; IV, inverse variance; CI, confidence interval; df, degree of freedom.

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