Ferri Claudio
MeSVA Department, University of L'Aquila, Delta 6 Bldg, 67100, Coppito, L'Aquila, Italy,
High Blood Press Cardiovasc Prev. 2015 Jun;22(2):103-11. doi: 10.1007/s40292-015-0078-3. Epub 2015 Feb 6.
Chronic obstructive pulmonary disease (COPD) is frequently accompanied by multimorbidities in affected patients. Even though the majority of these comorbidities are also related to advanced age and cigarette smoke, also COPD itself has significant impact on insurgence, or worsening of these conditions. As a consequence, COPD is regarded as a complex disease with pulmonary and extra-pulmonary involvement. According to current guidelines for the management of COPD patients, the comprehensive treatment of this condition should target respiratory symptoms as well as comorbidities. Cardiovascular disease is one of the most frequent comorbidities in COPD patients and there are several strategies for reducing the risk of cardiovascular disease in COPD patients. These include smoking cessation, pharmacologic prevention of cardiovascular disease, and the treatment of COPD. Beta-blockers for the prevention of cardiovascular disease have been traditionally limited in COPD patients, albeit current evidence supporting their efficacy and safety in these patients. With regard to COPD medications, corticosteroids are generally not recommended, except for exacerbations, while long-acting beta2-agonists have demonstrated an acceptable profile of cardiovascular safety. Long-acting anticholinergic bronchodilators, in particular tiotropium in the mist inhaler formulation, have been associated with an increased risk of major cardiovascular events and mortality. Data on this issue remain, however, controversial. Glycopyrronium, a recently introduced anticholinergic, demonstrated. a rapid and sustained relief of respiratory symptoms with a favorable safety profile and no increase in cardiovascular risk, in monotherapy and in combination with a long-acting beta2-agonist in a comprehensive trial program indicating a valid option for COPD patients with CV comorbidities.
慢性阻塞性肺疾病（COPD）患者常伴有多种合并症。尽管这些合并症大多也与高龄和吸烟有关，但COPD本身对这些疾病的发生或恶化也有重大影响。因此，COPD被视为一种涉及肺部和肺外的复杂疾病。根据目前COPD患者的管理指南，这种疾病的综合治疗应针对呼吸道症状以及合并症。心血管疾病是COPD患者最常见的合并症之一，有几种策略可降低COPD患者患心血管疾病的风险。这些策略包括戒烟、心血管疾病的药物预防以及COPD的治疗。传统上，用于预防心血管疾病的β受体阻滞剂在COPD患者中使用受限，尽管目前有证据支持其在这些患者中的疗效和安全性。关于COPD药物，除了急性加重期外，一般不推荐使用皮质类固醇，而长效β2受体激动剂已显示出可接受的心血管安全性。长效抗胆碱能支气管扩张剂，特别是雾化吸入剂型的噻托溴铵，与主要心血管事件风险和死亡率增加有关。然而，关于这个问题的数据仍存在争议。格隆溴铵是一种最近引入的抗胆碱能药物，在一项综合试验项目中，无论是单药治疗还是与长效β2受体激动剂联合使用，都显示出能快速、持续缓解呼吸道症状，安全性良好且不会增加心血管风险，这表明它是患有心血管合并症的COPD患者的一个有效选择。
