In patients with moderate to severe chronic obstructive pulmonary disease (COPD) and pulmonary hypertension (PH), bosentan plus best conventional care produced greater improvement in cardiovascular parameters than best conventional care alone.

Pietro B. Bracciale, MD, Department of Respiratory Disease, San Pietro Vernotico Hospital, Brindisi, Italy, reported the findings on November 3 here at CHEST 2009, the annual meeting of the American College of Chest Physicians.

For the study, 40 patients with moderate to severe COPD and PH were treated with best conventional care for 1 month, at which time they were reassessed. Patients with persistent PH (not reversible during oxygen administration) were randomised to receive placebo plus conventional treatment or to bosentan 125 mg BID plus conventional care for 18 months.

Pulmonary function tests, Doppler echocardiography, right heart catheterisation, 6-minute-walk test distance (6MWD), blood gas analysis, and quality of life were assessed at the beginning and end of the study. Of the patients, 32 completed the study (16 in each group).

After 18 months of treatment, there were significant changes from baseline in the bosentan combination group but not in the conventional treatment group for mean pulmonary artery pressure (P = .002 vs NS), mean pulmonary vascular resistance (P = .0115 vs NS), distance on the 6MWD (P = .0027 vs NS), World Health Organization Functional Class (P = .05 vs NS), and the body mass index, airway obstruction, dyspnoea, and exercise capacity index (P = .002 vs NS).

According to Dr. Bracciale, bosentan should be a useful early treatment for patients affected by PH and moderate to severe COPD before pathologic vessel changes have occurred. The beneficial effect of bosentan may be partially linked to its vasodilating action and its effect on vascular remodelling.