Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City, QC, Canada.
Pulmonary Department, Mainz University Hospital, Mainz, Germany.
Chest. 2018 Jun;153(6):1315-1325. doi: 10.1016/j.chest.2018.01.008. Epub 2018 Jan 31.
Cardiovascular disease is a frequent comorbidity in patients with COPD. Many physicians, particularly pulmonologists, are reluctant to use β-adrenoceptor blocking agents (β-blockers) in patients with COPD, despite their proven effectiveness in preventing cardiovascular events.
The large (5,162 patients) phase III TONADO 1 and 2 studies assessed lung function and patient-reported outcomes in patients with moderate to very severe COPD receiving long-acting bronchodilator treatment across 1 year. This post hoc analysis characterized lung-function changes, patient-reported outcomes, and safety in the subgroup of patients receiving β-blockers in the studies.
In total, 557 of 5,162 patients (11%) received β-blockers at baseline. Postbronchodilator FEV at baseline was higher in the β-blocker group (1.470 L) compared with that in the no β-blocker group (1.362 L). As expected, patients receiving β-blockers had a more frequent history of cardiovascular comorbidities and medications. Lung function improved from baseline in patients with or those without β-blocker treatment, and no relevant between-group differences were observed in trough FEV or trough FVC at 24 or 52 weeks. No relevant differences were observed for St. George's Respiratory Questionnaire results and Transition Dyspnea Index in patients with β-blockers compared with those in patients without. Safety findings were comparable between groups.
Lung function, overall respiratory status, and safety of tiotropium/olodaterol were not influenced by baseline β-blocker treatment in patients with moderate to very severe COPD. Results from this large patient cohort support the cautious and appropriate use of β-blockers in patients with COPD and cardiovascular comorbidity.
ClinicalTrials.gov; No.: NCT01431274 and No. NCT01431287; URL: www.clinicaltrials.gov.
心血管疾病是 COPD 患者常见的合并症。尽管β-肾上腺素受体阻滞剂（β 受体阻滞剂）已被证实可有效预防心血管事件，但许多医生，尤其是肺科医生，不愿在 COPD 患者中使用此类药物。
大型（5162 例患者）III 期 TONADO 1 和 2 研究评估了接受长效支气管扩张剂治疗的中重度至重度 COPD 患者在 1 年内的肺功能和患者报告结局。本事后分析描述了研究中接受β受体阻滞剂治疗患者的肺功能变化、患者报告结局和安全性。
共有 5162 例患者中有 557 例（11%）基线时接受β受体阻滞剂治疗。与未使用β受体阻滞剂组相比，接受β受体阻滞剂治疗的患者支气管扩张剂后 FEV1 更高（1.470 L 比 1.362 L）。正如预期的那样，接受β受体阻滞剂治疗的患者具有更频繁的心血管合并症和药物治疗史。接受或不接受β受体阻滞剂治疗的患者肺功能均从基线改善，在 24 或 52 周时，两组间在 FEV1 谷值或 FVC 谷值方面无显著差异。在接受β受体阻滞剂治疗的患者与未接受者之间，圣乔治呼吸问卷结果和呼吸困难过渡指数未见显著差异。两组间的安全性发现相当。
在中重度至重度 COPD 患者中，基线β受体阻滞剂治疗并未影响噻托溴铵/奥达特罗的肺功能、整体呼吸状况和安全性。来自该大型患者队列的结果支持在 COPD 合并心血管合并症患者中谨慎和适当使用β受体阻滞剂。
ClinicalTrials.gov；编号：NCT01431274 和 NCT01431287；网址：www.clinicaltrials.gov。
