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Review
. 2025 Jul 3;15(3):e70119.
doi: 10.1002/pul2.70119. eCollection 2025 Jul.

Practical Considerations for Managing Patients on Tyvaso DPI (Treprostinil Inhalation Powder)

Jennifer H Keeley  1 , Jacqueline Skarre  2 , Lori Reed  3 , Loida A Johnson  4 , Catherine Falardeau  5 , Brittany N J Davis  6 , Manisit Das  6 , Howard Castillo  6 , Susanne McDevitt  7
Affiliations
Review

Practical Considerations for Managing Patients on Tyvaso DPI (Treprostinil Inhalation Powder)

Jennifer H Keeley et al. Pulm Circ. .

Abstract

Pulmonary arterial hypertension (PAH) and pulmonary hypertension associated with interstitial lung disease (PH-ILD) require a multifaceted, guideline-directed management approach. This includes active patient participation in partnership with their healthcare team to minimize disease impact and improve survival. Inhaled treprostinil, a prostacyclin analog, has been approved for both PAH and PH-ILD in two formulations: Tyvaso (treprostinil nebulizer) and the more recent Tyvaso DPI (treprostinil dry powder inhaler) [United Therapeutics]. Both formulations deliver therapy directly to the lung vasculature, minimizing the risk of ventilation-perfusion mismatch, reducing systemic exposure, and decreasing the incidence of adverse events commonly associated with parenteral and oral prostacyclin formulations. While practical recommendations for the treprostinil nebulizer have been previously published, Tyvaso DPI provides a well-tolerated, convenient administration option for patients requiring prostacyclin therapy. This review provides an overview of inhaled prostacyclin therapy with a focus on practical considerations for managing PAH and PH-ILD patients treated with Tyvaso DPI. Recommendations from a panel of pulmonary hypertension advanced practice providers include patient selection, education, communication, onboarding and monitoring, transition and titration, side effect mitigation, and the availability of clinician- and patient-facing resources.

Keywords: pulmonary arterial hypertension; pulmonary hypertension associated with interstitial lung disease, treprostinil dry powder inhaler; side effect management; titration; tolerability.

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Conflict of interest statement

Jennifer H. Keeley has received honoraria for consulting and speaking services from Johnson & Johnson, Gossamer Bio, and Merck Pharmaceuticals, honoraria for speaking symposiums and consultation from United Therapeutics, and advisory board compensation from Gossamer Bio, Johnson & Johnson, and Merck Pharmaceuticals. Lori Reed has received honoraria for speaking and consultant services for United Therapeutics, Johnson & Johnson, and Merck, and advisory board compensation from United Therapeutics, Johnson & Johnson, and Liquidia. Catherine Falardeau has received honoraria for speaking services for United Therapeutics. Brittany N.J. Davis was an employee of United Therapeutics Corporation at the time of manuscript submission and might have received stock or stock options. Manisit Das is an employee of and may have received stock or stock options from United Therapeutics. Howard Castillo is an employee of and may have received stock or stock options from United Therapeutics. Susanne McDevitt has served as a scientific consultant and sub‐investigator for Gossamer Bio, Johnson & Johnson, Liquidia, Merck, and United Therapeutics. Jacqueline Skarre and Loida A. Johnson have nothing to disclose.

Figures

Figure 1
Figure 1
Patient flowchart for providers.
Figure 2
Figure 2
Device positioning and breathing technique. Correct device positioning for (a) Tyvaso and (b) Tyvaso DPI. (c) Incorrect device positioning for Tyvaso DPI. (d) Tyvaso DPI breathing technique.
Figure 3
Figure 3
Comparison of Tyvaso DPI cartridge dose to Tyvaso nebulizer dose: a guide for transitions.
See this image and copyright information in PMC

References

    1. Humbert M., Kovacs G., Hoeper M. M., et al., “2022 ESC/ERS Guidelines for the Diagnosis and Treatment of Pulmonary Hypertension,” European Heart Journal 43, no. 38 (October 2022): 3618–3731. - PubMed
    1. Kovacs G., Bartolome S., Denton C. P., et al., “Definition, Classification and Diagnosis of Pulmonary Hypertension,” European Respiratory Journal 64, no. 4 (October 2024): 2401324. - PMC - PubMed
    1. Nathan S. D., Shlobin O. A., Ahmad S., et al., “Serial Development of Pulmonary Hypertension in Patients With Idiopathic Pulmonary Fibrosis,” Respiration 76, no. 3 (2008): 288–294. - PubMed
    1. Nathan S. D. and Hassoun P. M., “Pulmonary Hypertension due to Lung Disease and/or Hypoxia,” Clinics in Chest Medicine 34, no. 4 (December 2013): 695–705. - PubMed
    1. Sahay S., Tsang Y., Flynn M., Agron P., and Dufour R., “Burden of Pulmonary Hypertension in Patients With Portal Hypertension in the United States: A Retrospective Database Study,” Pulmonary Circulation 10, no. 4 (November 2020): 2045894020962917. - PMC - PubMed

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