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Inhaled Treprostinil for the Treatment of Pulmonary Arterial Hypertension

Abby Poms

Martha Kingman


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Conference: 2011 PH Professional Network Symposium

Release Date: 09.22.2011

Presentation Type: Abstracts

Abby Poms, RRT1 and Martha Kingman, FNP-C, DNP2
1. UT Southwestern Medical Center, Dallas, TX 
2. Duke University Medical Center, Durham, NC

PURPOSE: This poster will cover an introduction to inhaled treprostinil. Dose titration, including the package insert information, as well as more rapid escalation options will be provided. Tips for managing common side effects of inhaled treprostinil will be outlined in detail.

BACKGROUND: Patients with progressive PAH despite oral therapy with endothelin receptor antagonists and/or PDE5 inhibitors, and those with severe disease typically require the addition of a prostanoid. Inhaled prostanoids generally are added to oral therapy for patients with early NYHA FC III symptoms, or in those who are not candidates for parenteral therapy. They can be added to the medication regimen of PAH patients who are declining or not improving on oral therapy.

IMPLICATIONS: The advantage of inhaled prostanoid therapy is the delivery of medication directly to the lungs, which results in less systemic absorption, and potentially, less severe systemic side effects. Additionally, the inhaled approach offers an alternative for some patients unable to manage or tolerate parenteral therapy, which requires an infusion pump and carries a risk for blood stream infections or infusion site reactions. However, if patients on inhaled prostanoids experience clinical worsening as evidenced by worsening symptoms, a significant decrease in 6MWD, decline in right ventricular function or worsening hemodynamics, oxygenation or FC, they may benefit from a parenteral prostacyclin. Those patients with more severe disease (late FC III or FC IV) should be placed on a parenteral prostanoid whenever possible.