Olschewski H, Canepa M, Kovacs G
Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria.
Cardiovascular Unit, Department of Internal Medicine, University of Genova, Genova, Italy.
Herz. 2019 Sep;44(6):517-521. doi: 10.1007/s00059-019-4834-3.
Chronic heart and lung diseases are very common in the elderly population. The combination of chronic heart failure and chronic obstructive pulmonary disease (COPD) is also common and, according to current guidelines, these patients should be treated for both diseases. In patients with heart failure, beta-blockers are very important drugs because their use is associated with significantly improved morbidity and mortality. These beneficial effects were documented in patients with and without COPD, although theoretically there is a risk for bronchoconstriction, particularly with non-beta selective blockers. In COPD patients, long-acting sympathomimetics (LABA) improve lung function, dyspnea, and quality of life and their combination with a beta-blocker makes sense from a pharmacological and a clinical point of view, because any potential arrhythmogenic effects of the LABA will be ameliorated by the beta-blocker. Inhaled tiotropium, a long-acting muscarinic antagonist (LAMA), has been extensively investigated and no safety concerns were reported in terms of cardiac adverse effects. The same applies for the other approved LAMA preparations and LAMA-LABA combinations. Severe COPD causes air-trapping with increasing pressures in the thorax, leading to limitations in blood return into the thorax from the periphery of the body. This causes a decrease in stroke volume and cardiac index and is associated with dyspnea. All these adverse effects can be ameliorated by potent anti-obstructive therapy as recently shown by means of a LABA-LAMA combination.
慢性心肺疾病在老年人群中非常常见。慢性心力衰竭和慢性阻塞性肺疾病（COPD）并存也很常见，根据现行指南，这些患者应同时治疗这两种疾病。在心力衰竭患者中，β受体阻滞剂是非常重要的药物，因为使用它们与显著降低发病率和死亡率相关。这些有益效果在有或没有COPD的患者中都得到了证实，尽管从理论上讲存在支气管收缩的风险，尤其是使用非β选择性阻滞剂时。在COPD患者中，长效拟交感神经药（LABA）可改善肺功能、呼吸困难和生活质量，从药理学和临床角度来看，将其与β受体阻滞剂联合使用是合理的，因为β受体阻滞剂可减轻LABA任何潜在的致心律失常作用。吸入用噻托溴铵，一种长效毒蕈碱拮抗剂（LAMA），已得到广泛研究，未报告有关心脏不良反应的安全问题。其他已获批的LAMA制剂和LAMA-LABA联合制剂也是如此。严重的COPD导致气体潴留，胸腔压力升高，导致从身体外周回流到胸腔的血液受限。这会导致每搏输出量和心脏指数下降，并伴有呼吸困难。正如最近通过LABA-LAMA联合治疗所显示的，所有这些不良反应都可以通过有效的抗阻塞治疗得到改善。
