Statsenko M E, Derevianchenko M V
Kardiologiia. 2012;52(12):57-63.
Review is devoted to the place of β-adrenoblockers in the treatment of cardiovascular disease (CVD) in patients with chronic obstructive pulmonary disease (COPD). Currently, it is expedient to use cardioselective -adrenoblockers, such as bisoprolol, metoprolol succinate, carvedilol and nebivolol for the treatment of patients with CVD and COPD. Bisoprolol has the greatest (of all the cardioselective β-adrenoblockers) evidence base of data on the efficacy and safety of using in patients with COPD and CVD. While using a cardioselective β-adrenoblockers external respiration function (ERF) should be controlled. When clinical signs of worsening airway conductance appear, and adverse effects on ERF parameters are observed, β-adrenoblockers dosage should be reduced, while maintaining lower respiratory functions need to be canceled. In general, the use of cardioselective β-adrenoblockers in patients with CVD and COPD is safe, and the benefits of the drugs in this group exceed the risks of exacerbation of COPD. If possible the use of 2-agonists should be limited in patients with CVD in the treatment of COPD because of their negative impact on the cardiovascular system - the preferred use of anticholinergic drugs.
综述致力于探讨β-肾上腺素能阻滞剂在慢性阻塞性肺疾病（COPD）患者心血管疾病（CVD）治疗中的地位。目前，使用比索洛尔、琥珀酸美托洛尔、卡维地洛和奈必洛尔等心脏选择性β-肾上腺素能阻滞剂治疗CVD和COPD患者是适宜的。比索洛尔（在所有心脏选择性β-肾上腺素能阻滞剂中）在COPD和CVD患者中使用的疗效和安全性方面拥有最充分的数据证据。使用心脏选择性β-肾上腺素能阻滞剂时，应控制外部呼吸功能（ERF）。当出现气道传导恶化的临床体征且观察到对ERF参数有不良影响时，应减少β-肾上腺素能阻滞剂的剂量，而在维持较低呼吸功能需要取消时则应停药。总体而言，在CVD和COPD患者中使用心脏选择性β-肾上腺素能阻滞剂是安全的，并且该类药物在这组患者中的益处超过了COPD加重的风险。若有可能，在CVD患者治疗COPD时应限制使用β2-激动剂，因为其对心血管系统有负面影响——首选使用抗胆碱能药物。
