Jabbal S, Anderson W, Short P, Morrison A, Manoharan A, Lipworth B J
From the Scottish Centre for Respiratory Research, Division of Molecular & Clinical Medicine, Ninewells Hospital & Medical School, Dundee, DD19SY, UK.
QJM. 2017 Dec 1;110(12):785-792. doi: 10.1093/qjmed/hcx155.
Beta-blockers remain underused in patients with chronic obstructive pulmonary disease (COPD) and cardiovascular disease.
We compared how different inhaled therapies affect tolerability of bisoprolol and carvedilol in moderate to severe COPD.
A randomized, open label, cross-over study.
We compared the cardiopulmonary interactions of bisoprolol 5 mg qd or carvedilol 12.5 mg bid for 6 weeks in conjunction with: (i) triple: inhaled corticosteroid/long acting beta-agonist/long acting muscarinic antagonist (ICS + LABA + LAMA), (ii) dual: ICS + LABA and (iii) ICS alone.
Eighteen patients completed, all ex-smokers, mean age 65 years, forced expiratory volume in 1 s (FEV1) 52% predicted. Bisoprolol and carvedilol produced comparable significant reduction in resting and exercise heart rate. FEV1, forced vital capacity and lung compliance (AX) were significantly lower with carvedilol vs. bisoprolol while taking concomitant ICS/LABA (P < 0.05) but not ICS/LABA/LAMA.
In summary, bisoprolol was better tolerated than carvedilol on pulmonary function at doses which produced equivalent cardiac beta-1 blockade. Worsening of pulmonary function with carvedilol was mitigated by concomitant inhaled LAMA (tiotropium) with LABA (formoterol), but not LABA alone. Registered at clinicaltrials.gov: NCT01656005.
β受体阻滞剂在慢性阻塞性肺疾病（COPD）和心血管疾病患者中的使用仍不充分。
我们比较了不同吸入疗法对中重度COPD患者比索洛尔和卡维地洛耐受性的影响。
一项随机、开放标签、交叉研究。
我们比较了比索洛尔5mg每日一次或卡维地洛12.5mg每日两次连续6周与以下联合用药时的心肺相互作用：（i）三联疗法：吸入性糖皮质激素/长效β受体激动剂/长效毒蕈碱拮抗剂（ICS+LABA+LAMA），（ii）双联疗法：ICS+LABA，以及（iii）单独使用ICS。
18名患者完成研究，均为既往吸烟者，平均年龄65岁，1秒用力呼气量（FEV1）为预测值的52%。比索洛尔和卡维地洛在静息和运动心率方面产生了相当显著的降低。在同时使用ICS/LABA时，与比索洛尔相比，卡维地洛使FEV1、用力肺活量和肺顺应性（AX）显著降低（P<0.05），但在同时使用ICS/LABA/LAMA时未出现此情况。
总之，在产生等效心脏β1受体阻滞作用的剂量下，比索洛尔在肺功能方面的耐受性优于卡维地洛。卡维地洛导致的肺功能恶化可通过同时吸入LAMA（噻托溴铵）和LABA（福莫特罗）得到缓解，但单独使用LABA则不能。在clinicaltrials.gov注册：NCT01656005。
