Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, No.579, Sec. 2, Yunlin Rd., Douliu City, Yunlin County, 640, Taiwan, Republic of China.
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Taiwan University Hospital, and College of Medicine, National Taiwan University, Taipei, Taiwan.
BMC Pulm Med. 2019 Dec 3;19(1):233. doi: 10.1186/s12890-019-0999-z.
While inhaled bronchodilators reduce symptoms and acute exacerbations of chronic obstructive pulmonary disease (COPD), their use is associated with increased cardiovascular events in some studies. This study investigates the risk of adverse events associated with the use of inhaled bronchodilators in COPD patients with multimorbidity.
A case-control study was conducted between January 2015 and December 2017, and patients with spirometry-confirmed diagnosis of COPD (N = 1565) using inhaled long-acting bronchodilators were enrolled. Medical records were reviewed and clinical data, including age, gender, smoking status, major comorbidities, lung function stage, history of exacerbations, bronchodilator regimens, and treatment duration were analyzed. Major adverse cardiovascular events occurring during long-acting bronchodilator use were recorded.
The most common comorbidities were cardiovascular disease (CVD) (53.6%) and chronic kidney disease (CKD) (25.8%). We observed that CVD (odds ratio [OR], 5.77), CKD (OR, 2.02) and history of frequent exacerbations (OR, 2.37) were independent risk factors for cardiovascular events, regardless of the type of bronchodilators use. Moreover, COPD patients with both CKD and CVD had higher risk (6.32-fold) of adverse cardiovascular effects than those with neither comorbidity. Eighty-seven of 1565 (5.56%) COPD patients died during this study period. Of them, 21.8% (19/87) were cardiovascular-related and 73.6% (64/87) patients were respiratory-related mortality. Among COPD patients using long-acting bronchodilators, CKD was the only risk factor to predict cardiovascular events and cardiovascular-related mortality (OR, 4.87; 95% confidence interval [CI], 1.75-13.55].
COPD patients had higher risk of cardiovascular events were associated with their CVD and/or CKD comorbidities and history of frequent exacerbations, rather than associated with their use of inhaled bronchodilators.
虽然吸入性支气管扩张剂可减轻慢性阻塞性肺疾病（COPD）的症状和急性加重，但一些研究表明，其使用与心血管事件的增加有关。本研究旨在探讨合并多种疾病的 COPD 患者使用吸入性支气管扩张剂与不良事件之间的关系。
本病例对照研究于 2015 年 1 月至 2017 年 12 月进行，共纳入 1565 例接受吸入长效支气管扩张剂治疗的肺功能确诊 COPD 患者。回顾病历，分析包括年龄、性别、吸烟状况、主要合并症、肺功能分期、加重史、支气管扩张剂方案和治疗时间等临床数据。记录使用长效支气管扩张剂期间发生的主要不良心血管事件。
最常见的合并症为心血管疾病（CVD）（53.6%）和慢性肾脏病（CKD）（25.8%）。我们发现，无论支气管扩张剂的使用类型如何，CVD（比值比 [OR]，5.77）、CKD（OR，2.02）和频繁加重史（OR，2.37）都是心血管事件的独立危险因素。此外，同时患有 CKD 和 CVD 的 COPD 患者发生不良心血管事件的风险更高（6.32 倍）。在研究期间，1565 例 COPD 患者中有 87 例（5.56%）死亡。其中，21.8%（19/87）与心血管相关，73.6%（64/87）与呼吸相关。在使用长效支气管扩张剂的 COPD 患者中，CKD 是唯一预测心血管事件和心血管相关死亡的危险因素（OR，4.87；95%置信区间 [CI]，1.75-13.55）。
与 COPD 患者使用吸入性支气管扩张剂无关，而是与 CVD 和/或 CKD 合并症及频繁加重史相关，合并多种疾病的 COPD 患者发生心血管事件的风险更高。
