Rapid Iloprost Inhalation Improves Pulmonary Vascular Resistance in PAH

pulmonary hypertension x ray
PAH, pulmonary hypertension, pulmonary arterial hypertension, CTEPH
This study assessed improvement in pulmonary vascular resistance and cardiac index in patients with pulmonary arterial hypertension who rapidly inhale iloprost 2.5 ug via the Breelib™ nebulizer.

Rapid inhalation of iloprost 2.5 ug via the Breelib™ nebulizer (Vectura Group plc; Chippenham, United Kingdom) results in a substantial improvement in pulmonary vascular resistance (PVR) and cardiac index in patients with pulmonary arterial hypertension (PAH), according to prospective, single-arm, open-label, proof-of-concept study results published in Pulmonary Circulation.

Inhaled iloprost is an established part of PAH therapy, with the standard nebulizer inhalation session estimated to last up to ≥10 minutes. Thus, there has been interest in reducing inhalation times to improve convenience and adherence. In 2016, the European Union approved the Breelib nebulizer, which reduces median inhalation times; however, the acute hemodynamic and right ventricular (RV) response of rapid iloprost inhalation is unknown. Therefore, researchers evaluated the pulmonary hemodynamics, RV strain (measured by echocardiography in a subset of patients), and adverse events at baseline and at 5, 10, 15, and 30 minutes after the end of iloprost inhalation in 30 patients with PAH not treated with prostanoids.

They found that the median length of time needed to inhale iloprost 2.5 ug via the Breelib nebulizer was 4 (interquartile range: 2.8-5) minutes and PVR decreased rapidly and significantly after inhalation. The cardiac index showed a rapid and significant increase in response to iloprost inhalation and significant decreases from baseline in median oxygen saturation and partial pressure of oxygen. In 21 patients with available RV strain measurements, investigators found that RV longitudinal strain and mid-RV free wall statin showed no improvement after iloprost inhalation.

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“Our study shows a substantial decrease in afterload (PVR) after rapid inhalation of iloprost 2.5 mg via the Breelib™ nebulizer in [patients with PAH],” concluded the investigators.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Richter MJ, Wan J, Ghofrani HA, et al. Acute response to rapid iloprost inhalation using the Breelib™ nebulizer in pulmonary arterial hypertension: the Breelib™ acute study. Pulm Circ. 2019;9(3):1-3.