Sotatercept improves small airway disease and hyperinflation in patients with pulmonary hypertension

<title>Extract</title> Patients with pulmonary arterial hypertension (PAH) have a high prevalence of small airways disease (SAD) [1]. The mechanisms and implications of SAD in PAH are not entirely clear. Precapillary pulmonary hypertension (PH) occurs in cardiopulmonary conditions other than PAH, such as left heart failure, interstitial lung disease (ILD), chronic obstructive pulmonary disease (COPD), and sarcoidosis. SAD is highly prevalent in these conditions [2–5]. Sotatercept, an activin-signaling inhibitor, is an effective therapy approved for PAH [6]. We recently reported improved lung function, particularly indices of small airway function, following sotatercept treatment in patients with sarcoidosis-associated PH [7]. The aim of this present study was to assess changes in lung function in a broader group of patients with significant precapillary PH treated with sotatercept. We hypothesized that markers of SAD and hyperinflation would improve in patients with precapillary PH after treatment with sotatercept.