Clinical efficacy of bosentan in treatment of elderly patients with stable chronic obstructive pulmonary disease and pulmonary hypertension and the effect on right heart function

Yin Yiping; Zhang Min

doi:10.3760/j.issn.1673-4777.2019.12.007

Abstract：Objective To investigate the clinical efficacy of bosentan in treatment of elderly patients with stable chronic obstructive pulmonary disease (COPD) and pulmonary hypertension (PH) and the effect on right heart function.Methods Clinical data of 86 elderly patients with stable COPD and PH admitted to Shiyan People's Hospital,Hubei Province from March 2017 to October 2018 were retrospectively analyzed.All patients were treated with symptomatic treatments including oxygen inhalation,anti-infection and water-electrolyte balance control;42 patients had salmeterol/fluticasone inhalation(routine group) and 44 patients took bosentan additionally (bosentan group).Serological indicators [endothelin-1 (ET-1),adrenomedullin (ADM),hypoxia-inducible factor-1α(HIF-1α)],hypoxic indicators [arterial partial pressure of oxygen (PaO2),arterial partial pressure of carbon dioxide(PaCO2)],lung function indicators[6 min walking distance(6MWD),Modified Medical Research Council(MMRC) Dyspnea Scale],PH indicators[pulmonary arterial systolic pressure(PASP),pulmonary arterial diastolic blood pressure(PADP),pulmonary arterial mean pressure(PAMP)],right cardiac function indicators [right ventricular sidewall tricuspid annular plane systolic excursion(TAPSE),right ventricular sidewall tricuspid annular plane systolic peak velocity (PSv),right ventricular myocardial work index (Tei index)] and adverse reactions were analyzed after 12 weeks of treatment.Results After 12 weeks of treatment,ET-1,ADM,HIF-1α,PaCO2,MMRC score,PASP,PADP,PAMP and Tei index significantly decreased in both groups,and the indexes in the bosentan group were lower than those in the routine group(all P＜0.05);PaO2,6MWD,TAPSE and PSv significantly increased and these indexes in the bosentan group were higher than those in the routine group[(81 ±5)mmHg vs (77 ±5)mmHg,(385 ±32)m vs (341 ± 31)m,(18.9 ±2.1)mm vs (17.2 ± 2.1) mm,(14.5 ±1.5)cm/s vs (13.5 ± 1.6)cm/s] (all P ＜0.05).No liver function damage such as elevated transaminases was observed during treatment,and there was no significant difference in the incidence of adverse drug reactions between groups(P＞0.05).Conclusions Bosentan is safe and effective in treating elderly patients with stable COPD and PH.It can help alleviate PH,correct hypoxia and improve cardiopulmonary function.