KUMJ | VOL. 15 | NO. 4 | ISSUE 60 | OCT.-DEC. 2017
Effect of Sildenafil Citrate on Pulmonary Arterial Systolic Pressure and Sub-maximal Exercise Capacity in Chronic Obstructive Pulmonary Disease
Shrestha SK, Srivastava B, Karki M, Khatri DB, Pradhan RM
Abstract: Background
Pulmonary hypertension (PH) often complicates Chronic Obstructive Pulmonary
Disease (COPD). Sildenafil reduces pulmonary arterial pressure associated with
multitude of diseases.
Objective
To evaluate the use of Sildenafil in Pulmonary Hypertension associated with COPD.
Method
This randomized control study enrolled 72 patients: 61 completed the study. Thirty-
patients with COPD received Sildenafil 25 mg thrice daily and 31 patients with
COPD received optimal medical therapy for four weeks. Symptom assessment and
dyspnoea grading was done with modified Borg scale and Modified Medical Research
Council (MMRC) grade. The functional assessment was done with WHO functional
classification. The estimation of pulmonary arterial systolic pressure and six minute
walking distance was done before and after four weeks of the administration of
therapy in both groups. Adverse reaction profiling was done for Sildenafil. The
primary outcomes were the changes in pulmonary arterial systolic pressure and six
minute walk test. The secondary outcomes were change in modified Borg scale for
dyspnoea, MMRC grading and WHO functional class.
Result
The mean decrease in pulmonary arterial systolic pressure in Sildenafil group was
significant as compared to controls (9.87+7.84 mmHg Vs 5.93+7.44 mmHg, P=0.048).
The mean increase in six minute walk distance was significantly more in cases as
compared to controls (48.13+25.79 m Vs 32.59+32.96 m,P=0.047). The changes in
modified Borg scale was not significant (1.20+1.92 to 1.55+1.23; P=0.401). There was
significant changes in MMRC grade (p=0.037). There was no significant change in
WHO functional class after four weeks (p=0.071).
Conclusion
Sildenafil marginally decreased pulmonary arterial systolic pressure and increased six
minute walk distance in COPD patients. It improved MMRC grading without affecting
modified Borg’s Scale and WHO functional class.
Keyword : Chronic obstructive pulmonary disease, Pulmonary hypertension, Sildenafil, Six minute walk distance