Dr.S.Venkatesan MD

Sildenafil was first approved for pulmonary hypertension  in 2006  after a much hyped study called “SUPER” published in New  England journal of medicine.

This study population  included only  idiopathic pulmonary  hypertension and secondary  pulmonary hypertension due to pulmonary vascular disease like scleroderma  etc .The exclusion criteria were not clearly described in this paper ,  but it was clear PAH due to COPD was not included.

Please note , the title and conclusion are misleading .The real conclusion should be read as sildenefail may be useful some of the patients with in idiopathic PAH and secondary PAH sue to connective tissue disorders.

Further ,  the conclusion  of  SUPER study gave considerable  room for   misinterpretation (Intentional ? ) .The term PAH was used in too casual and generalised  manner. Many of the physicians  started  using sildenafil for every case of PAH including COPD.                 

COPD is a disorder of  airway , while sildenafil is a drug which acts on  the vascular  system (Vascular smooth muscle )  Apply your own logic  ,how  effective sildenafil  would be in  COPD patients .

As on today there is no good  evidence to suggest sildenafil will be useful in COPD. (Few studies  suggested it may be useful in fibrosed  lung)

Still , no body can prevent a physician  from testing this drug in otherwise refractory COPD as  we have a convenient   semantics called  ” off label  indication ”

So, the answer to the title  question still  eludes the majority    . . . even though many of us  know  the answer !

Ans : You   can use it  . . . but your patient   may not  really benefit ,  of course it satisfies  the physician and the drug company.

Reference

An editorial from Indian journal of chest diseases debates the issue

http://medind.nic.in/iae/t08/i4/iaet08i4p317.pdf

http://www.nejm.org/doi/pdf/10.1056/NEJMoa050010

http://www.nejm.org/doi/pdf/10.1056/NEJMc053442