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

Journal of Korean Medical Science 2013년 28권 8호 p.1200 ~ p.1206

박진경(Park Jin-Kyeong) - Wonkwang University Sanbon Hospital Department of Pulmonary and Critical Care Medicine
송주희(Song Ju-Hee) - University of Ulsan College of Medicine Asan Medical Center Department of Pulmonary and Critical Care Medicine
박동아(Park Dong-Ah) - National Evidence-Based Healthcare Collaborating Agency Office of Health Technology Evaluation
이재승(Lee Jae-Seoung) - University of Ulsan College of Medicine Asan Medical Center Department of Pulmonary and Critical Care Medicine
이상도(Lee Sang-Do) - University of Ulsan College of Medicine Asan Medical Center Department of Pulmonary and Critical Care Medicine
오연목(Oh Yeon-Mok) - University of Ulsan College of Medicine Asan Medical Center Asthma Center, and Clinical Research Department of Pulmonary and Critical Care Medicine

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.