Viagra En Hipertension Arterial Pulmonar

Archivos de Bronconeumologia is a scientific journal that preferentially publishes prospective original research articles whose content is based upon results dealing with several aspects of respiratory diseases such as epidemiology, pathophysiology, clinics, surgery, and basic investigation. Other types of articles such as reviews, editorials, a few special articles of interest to the society and the editorial board, scientific letters, letters to the Editor, and clinical images are also published in the Journal. It is a monthly Journal that publishes a total of 12 issues and a few supplements, which contain articles belonging to the different sections.

All the manuscripts received in the Journal are evaluated by the Editors and sent to expert peer-review while handled by the Editor and/or an Associate Editor from the team. The Journal is published monthly both in Spanish and English. Therefore, the submission of manuscripts written in either Spanish or English is welcome. Translators working for the Journal are in charge of the corresponding translations.

Manuscripts will be submitted electronically using the following web site: https://www.editorialmanager.com/ARBR/, link which is also accessible through the main web page of Archivos de Bronconeumologia.

Access to any published article, in either language, is possible through the Journal's web page as well as from PubMed, Science Direct, and other international databases. Furthermore, the Journal is also present in Twitter and Facebook. The Journal expresses the voice of the Spanish Respiratory Society of Pulmonology and Thoracic Surgery (SEPAR) as well as that of other scientific societies such as the Latin American Thoracic Society (ALAT) and the Iberian American Association of Thoracic Surgery (AICT).

Authors are also welcome to submit their articles to the Journal's open access companion title, Open Respiratory Archives.

Indexed in:

Current Contents/Clinical Medicine, JCR SCI-Expanded, Index Medicus/Medline, Excerpta Medica/EMBASE, IBECS, IME, SCOPUS, IBECS

Follow us:

Subscribe:

The Impact Factor measures the average number of citations received in a particular year by papers published in the journal during the two preceding years.

© Clarivate Analytics, Journal Citation Reports 2021

CiteScore measures average citations received per document published.

SRJ is a prestige metric based on the idea that not all citations are the same. SJR uses a similar algorithm as the Google page rank; it provides a quantitative and qualitative measure of the journal’s impact.

SNIP measures contextual citation impact by wighting citations based on the total number of citations in a subject field.

The treatment of pulmonary arterial hypertension (PHT) with prostacyclin in its different forms (intravenous, subcutaneous, inhaled, and oral) is effective from a clinical and functional point of view, although only intravenous prostacyclin (epoprostenol) has been shown to improve survival. 1 Treprostinil is a stable form of prostacyclin administered in continuous subcutaneous infusion. The most common adverse effect of this drug is pain in the injection area. Although this pain is usually controllable, sometimes it means that treatment must be suspended. 2

Sildenafil is a selective inhibitor of phosphodiesterase-5 (PDE-5) with pulmonary vasodilating effects. It has proven efficacy in diminishing pulmonary pressures in monotherapy and in combination with prostacyclin or nitric oxide. 2,3 We report the case of a patient suffering from severe PHT associated with systemic lupus erythematosus (SLE). Treatment with sildenafil was substituted for treprostinil due to incapacitating pain in the area of injection.

A 25-year old woman with SLE was diagnosed with PHT with no response to a vasoreactivity test with epoprostenol. The patient suffered repeated effort-related syncopes once treatment with inhaled prostacyclin began. For this reason treatment with subcutaneous prostacyclin, at a dose of up to 15 ng/kg/min in continuous infusion, was started in January 2002. Until then she had been clinically stable (New York Heart Association [NYHA] type 2, 460 m on foot, 6-minute walking test). The patient reported intense abdominal pain near the injection site, however, as the dose increased. The pain could not be controlled with topical or oral medication (an antiinflammatory drug and gabapentin).

Treatment with sildenafil was started on compassionate grounds with consent from the patient and from the health authorities. The starting dose was 25 mg every 12 hours. Initially the same dose of subcutaneous prostacyclin was maintained. Every 4 days the subcutaneous prostacyclin dose was reduced and the dose of sildenafil was increased until a stable dose of 25 mg every 6 hours was reached (Table). The abdominal pain remitted as soon as treatment with subcutaneous prostacyclin was discontinued. The patient remained stable 3 months later (NYHA type 2, 475 m on foot, 6-minute walking test) with sildenafil therapy alone. During follow-up, the treatment dose was increased to 50 mg every 8 hours (50 mg dose every 6 hours was not tolerated due to headaches). The patient remained stable and 9 months after the change of medication her condition was classified as NYHA type 1 (510 m on foot, 6-minute walking test). No further relevant adverse effects were detected.

Subcutaneous prostacyclin is effective in treating PHT in terms of short-term (3 months) clinical improvement 2 and has recently received approval for clinical use. Injection site pain is the most common adverse side effect (85%) and although it is often controllable by topical or oral medication (paracetamol, antiinflammatory drugs, gabapentin, or corticosteroids), treatment must sometimes be suspended (in 8% of cases in a double-blind trial).

Sildenafil is a selective inhibitor of PDE-5. The decrease in the nitric oxide production rate and in guanosine 3'5'-monophosphate (cGMP) activity contributes to the development of PHT in the pulmonary bed. Nitric oxide, produced in the vascular endothelium, has a very short half-life and is a very strong pulmonary vasodilator by guanylate cyclase activation, through which cGMP is produced. cGMP is degraded by phosphodiesterases, of which there are 11 known types. PDE-5 selectively deactivates cGMP and is widely present in the cavernous bodies of the penis and in the vascular pulmonary bed. Selective inhibition of PDE-5 with sildenafil induces nitric oxide dependent vasodilation mainly in the aforementioned regions. This is the reason for its efficacy in treating erectile dysfunction and for its potential beneficial effect in PTH.

That oral sildenafil alone, 4,5 combined with nitric oxide, 3,4 or with inhaled prostacyclin 5 causes vasodilation and a decrease in pulmonary pressure has been established experimentally. Although clinical experience is scarce, cases have been reported in which sildenafil was used to treat PHT, with clinically favorable outcome at a 3-month follow up. 7,9 Empirically established doses have varied greatly.

In our patient, the uncontrollable pain caused by the treprostinil injection required suspension of that drug. Treatment with sildenafil alone was not only effective in preventing possible deterioration due to withdrawal of treprostinil, but also led to improved short- and mid-term outcome at 9 months. To our knowledge, no other cases of substitution of prostacyclin by sildenafilin monotherapy have been reported.

Although there is little experience with sildenafil, it may be useful in treating PHT. The efficacy of this drug alone and combined with prostacyclin and the determination of the optimal dose are being studied in multicenter trials.

Correspondence: Dr. P. Escribano Subías.
Unidad de Hipertensión Pulmonar, Insuficiencia Cardíaca y Trasplante
Cardíaco. Servicio de Cardiología. Hospital Universitario 12 de Octubre.
Ctra. de Andalucía, km 5,4. 28041 Madrid. España.
E-mail: [email protected]

Manuscript received February 4, 2003.
Accepted for publication February 18, 2003.