PT  - JOURNAL ARTICLE
AU  - Andrew Goudie
AU  - Pippa Hopkinson
AU  - Brian Lipworth
AU  - Allan Struthers
TI  - Do <span class="underline">p</span>hosphodiesterase 5 inhibitors improve exercise capacity in patients with CO<span class="underline">P</span>D associated <span class="underline">p</span>ulmonary hypertension? (3P study)
DP  - 2013 Sep 01
TA  - European Respiratory Journal
PG  - P4063
VI  - 42
IP  - Suppl 57
4099  - http://erj.ersjournals.com/content/42/Suppl_57/P4063.short
4100  - http://erj.ersjournals.com/content/42/Suppl_57/P4063.full
SO  - Eur Respir J2013 Sep 01; 42
AB  - BackgroundPH complicates COPD, negatively influencing mortality, exercise tolerance and QOL. It is unknown whether pulmonary vasodilation through PDE5-inhibition has beneficial effects in COPD associated PH.AimsTo determine if PDE5-Is improve exercise capacity, QOL and cardiac function in COPD-PH.MethodsA randomised, double-blind, parallel group, placebo controlled study was conducted (60 patients per arm). The active arm received 10 mg daily tadalafil for 12 weeks. Primary endpoint: 6MWD. Secondary endpoints: SGRQ, SF-36 and Minnesota questionnaires (QOL); BNP; DLCO and echo parameters. Inclusion: moderate-severe COPD and PH [RVSP >30mmHg and/or a pulmonary acceleration time (PAT) <120ms]. Exclusion: LVSD, aortic stenosis or use of nitrates.Results (n=120)Mean FEV1 1.06±0.41 L (41% pred.), mPAP 30±7 mmHg (PAT derived), RVSP 42±10 mmHg. At 12 weeks the mean placebo corrected Δ6MWD=0.5m. Clinically significant divergence of QOL scores favoured the active group with between group differences of -4.41 95%CI(-9.20-0.38), p=0.071 for SGRQ activity levels and 4.08 95%CI(-1.35-9.52), p=0.139 for SF-36 physical function, although not statistically significant. No significant changes were noted in BNP, DLCO, or RV function (TAPSE). A significant between group ΔPAT occurred, 9.5ms 95% CI (3.24 to 12.56), p= 0.001.ConclusionsTadalafil did not increase 6MWD. Clinically significant QOL score divergence of >4 points occurred in domains of activity and physical function, favouring the active group. This warrants further exploration. An expected pulmonary vasodilatory effect as determined by PAT was found in the active group without significant change in RV function.