Key Angela, Parry Matthew, West Malcolm A, Asher Rebecca, Jack Sandy, Duffy Nick, Torella Francesco, Walker Paul P
Respiratory Department, Aintree University Hospitals NHS Foundation Trust, Liverpool, UK.
Respiratory Research Group, Aintree University Hospitals NHS Foundation Trust, Liverpool, UK.
BMJ Open Respir Res. 2017 Apr 5;4(1):e000164. doi: 10.1136/bmjresp-2016-000164. eCollection 2017.
β Blockers are important treatment for ischaemic heart disease and heart failure; however, there has long been concern about their use in people with chronic obstructive pulmonary disease (COPD) due to fear of symptomatic worsening of breathlessness. Despite growing evidence of safety and efficacy, they remain underused. We examined the effect of β-blockade on lung function, exercise performance and dynamic hyperinflation in a group of vascular surgical patients, a high proportion of who were expected to have COPD.
People undergoing routine abdominal aortic aneurysm (AAA) surveillance were sequentially recruited from vascular surgery clinic. They completed plethysmographically measured lung function and incremental cardiopulmonary exercise testing with dynamic measurement of inspiratory capacity while taking and not taking β blocker.
48 participants completed tests while taking and not taking β blockers with 38 completing all assessments successfully. 15 participants (39%) were found to have, predominantly mild and undiagnosed, COPD. People with COPD had airflow obstruction, increased airway resistance (Raw) and specific conductance (sGaw), static hyperinflation and dynamically hyperinflated during exercise. In the whole group, β-blockade led to a small fall in FEV1 (0.1 L/2.8% predicted) but did not affect Raw, sGaw, static or dynamic hyperinflation. No difference in response to β-blockade was seen in those with and without COPD.
In people with AAA, β-blockade has little effect on lung function and dynamic hyperinflation in those with and without COPD. In this population, the prevalence of COPD is high and consideration should be given to case finding with spirometry.
NCT02106286.
β受体阻滞剂是缺血性心脏病和心力衰竭的重要治疗药物；然而，长期以来人们一直担心其在慢性阻塞性肺疾病（COPD）患者中的使用，因为担心会导致呼吸急促症状加重。尽管越来越多的证据表明其安全性和有效性，但它们的使用仍然不足。我们研究了β受体阻滞剂对一组血管外科患者肺功能、运动能力和动态肺过度充气的影响，这些患者中很大一部分预计患有COPD。
从血管外科诊所连续招募接受常规腹主动脉瘤（AAA）监测的患者。他们在服用和未服用β受体阻滞剂的情况下完成了通过体积描记法测量的肺功能以及递增式心肺运动测试，并动态测量吸气量。
48名参与者在服用和未服用β受体阻滞剂的情况下完成了测试，其中38名成功完成了所有评估。发现15名参与者（39%）主要患有轻度且未经诊断的COPD。COPD患者存在气流阻塞、气道阻力（Raw）增加、比传导率（sGaw）增加、静态肺过度充气以及运动时动态肺过度充气。在整个组中，β受体阻滞剂导致FEV1略有下降（0.1升/预测值的2.8%），但不影响Raw、sGaw、静态或动态肺过度充气。在患有和未患有COPD的患者中，对β受体阻滞剂的反应没有差异。
在AAA患者中，β受体阻滞剂对患有和未患有COPD的患者的肺功能和动态肺过度充气影响很小。在这一人群中，COPD的患病率很高，应考虑通过肺活量测定进行病例筛查。
NCT02106286。
