Continuous intravenous infusion of epoprostenol (prostacyclin) is an effective treatment for primary pulmonary hypertension. This approach requires the insertion of a permanent central venous catheter, with the associated risk of serious complications. Recently, aerosolized iloprost, a stable prostacyclin analogue, has been introduced as an alternative therapy for severe pulmonary hypertension.

We evaluated the effects of aerosolized iloprost on exercise capacity and hemodynamic variables over a one-year period in patients with primary pulmonary hypertension.

Twenty-four patients with primary pulmonary hypertension received aerosolized iloprost at a daily dose of 100 or 150 μg for at least one year. The mean (±SD) distance covered in the six-minute walk test increased from 278±96 m at base line to 363± 135 m after 12 months (P<0.001). During the same period, the mean pulmonary arterial pressure before the inhalation of iloprost declined from 59±10 mm Hg to 52±15 mm Hg (P=0.006), cardiac output increased from 3.8±1.4 liters per minute to 4.4±1.3 liters per minute (P=0.02), and pulmonary vascular resistance declined from 1205±467 dyn․sec․cm^–5 to 925±469 dyn․sec․cm^–5 (P<0.001). The treatment was generally well tolerated, except for mild coughing, minor headache, and jaw pain in some patients.

Long-term treatment with aerosolized iloprost is safe and has sustained effects on exercise capacity and pulmonary hemodynamics in patients with primary pulmonary hypertension.