Kato Mahoto, Komamura Kazuo, Kitakaze Masafumi, Hirayama Atsushi
Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi Kamicho, Itabashi, Tokyo 173-8610, Japan.
Division of Medical Technology Faculty of Nutrition, Kobe Gakuin University, Kobe 651-2180, Japan.
Diseases. 2017 Dec 28;6(1):4. doi: 10.3390/diseases6010004.
In older adults, chronic obstructive pulmonary disease (COPD) is commonly associated with heart failure with reduced ejection fraction (HFrEF), and the high prevalence of this combination suggests that customized treatment is highly necessary in patients with COPD and HFrEF. To investigate whether the treatment of COPD with tiotropium, an anticholinergic bronchodilator, reduces the severity of heart failure in patients with HFrEF complicated by mild to moderate COPD, forty consecutive participants were randomly divided into two groups and enrolled in a crossover design study. Group A inhaled 18 μg tiotropium daily for 28 days and underwent observation for another 28 days. Group B completed the 28-day observation period first and then received tiotropium inhalation therapy for 28 days. Pulmonary and cardiac functions were measured on days 1, 29, and 56. In both groups, 28 days of tiotropium inhalation therapy substantially improved the left ventricular ejection fraction (from 36.3 ± 2.4% to 41.8 ± 5.9%, < 0.01, in group A; from 35.7 ± 3.8% to 41.6 ± 3.8%, < 0.01, in group B) and plasma brain natriuretic peptide levels (from 374 ± 94 to 263 ± 92 pg/mL, < 0.01, in group A; from 358 ± 110 to 246 ± 101 pg/mL, < 0.01, in group B). Tiotropium inhalation therapy improves pulmonary function as well as cardiac function, and reduces the severity of heart failure in patients with compensated HFrEF with concomitant mild to moderate COPD.
在老年人中，慢性阻塞性肺疾病（COPD）通常与射血分数降低的心力衰竭（HFrEF）相关，这种合并症的高患病率表明，对COPD和HFrEF患者进行定制化治疗非常必要。为了研究使用抗胆碱能支气管扩张剂噻托溴铵治疗COPD是否能降低合并轻度至中度COPD的HFrEF患者的心力衰竭严重程度，40名连续入选的参与者被随机分为两组，并参与一项交叉设计研究。A组每天吸入18μg噻托溴铵，持续28天，然后再进行28天的观察。B组先完成28天的观察期，然后接受噻托溴铵吸入治疗28天。在第1天、第29天和第56天测量肺功能和心脏功能。在两组中，28天的噻托溴铵吸入治疗均显著改善了左心室射血分数（A组从36.3±2.4%提高到41.8±5.9%，<0.01；B组从35.7±3.8%提高到41.6±3.8%，<0.01）以及血浆脑钠肽水平（A组从374±94降至263±92pg/mL，<0.01；B组从358±110降至246±101pg/mL，<0.01）。噻托溴铵吸入治疗可改善肺功能和心脏功能，并降低合并轻度至中度COPD的代偿性HFrEF患者的心力衰竭严重程度。
