Di Tano Giuseppe, Frattini Silvia, Pirelli Salvatore
U.O. di Cardiologia, Aziensa Istituti Ospitalieri, Cremona.
G Ital Cardiol (Rome). 2011 Sep;12(9):588-95. doi: 10.1714/926.10172.
Although current guidelines support the use of beta-blockers (BB) in all patients with symptomatic heart failure (HF) and left ventricular systolic dysfunction, unless contraindicated or not tolerated, they are still underused, especially in patients with chronic obstructive pulmonary disease (COPD). BB are associated with a potential risk for lung function decline and airway hyperresponsiveness, and reluctance still exists to prescribe these agents in COPD patients. However, a large body of evidence indicates that these patients tolerate well selective beta-blockade, and BB should not be denied to HF patients with concomitant COPD. Current guidelines and recent reports recommend the use of selective BB in all patients with stable COPD and irreversible airway obstruction, to be administered at the lowest dose and at a low titration rate. Close monitoring of lung function by spirometry is strongly encouraged to guide and enhance a safe BB use in everyday practice. Pneumologists and cardiologists should develop shared strategies with the aim to implement selective BB therapy in clinical practice and improve the prognosis of both HF and COPD.
尽管当前指南支持在所有有症状的心力衰竭（HF）和左心室收缩功能障碍患者中使用β受体阻滞剂（BB），除非有禁忌或不耐受情况，但它们的使用仍然不足，尤其是在慢性阻塞性肺疾病（COPD）患者中。BB与肺功能下降和气道高反应性的潜在风险相关，在COPD患者中开具这些药物仍存在顾虑。然而，大量证据表明这些患者对选择性β受体阻滞耐受性良好，不应拒绝给合并COPD的HF患者使用BB。当前指南和近期报告建议在所有稳定的COPD和不可逆气道阻塞患者中使用选择性BB，以最低剂量和低滴定速率给药。强烈鼓励通过肺功能仪密切监测肺功能，以指导并促进在日常实践中安全使用BB。呼吸科医生和心脏病专家应制定共同策略，以便在临床实践中实施选择性BB治疗，并改善HF和COPD患者的预后。
