Cardiovascular Effects of β-Agonists in Patients With Asthma and COPD

Extrapulmonary comorbidities in chronic obstructive pulmonary disease: state of the art

“…Existing data does not support the idea that chronic respiratory medication induces cardiac arrhythmia, excluding sinus tachycardia [33,53]. The management of COPD should not generally be altered for those with atrial fibrillation aside from any potential interactions with warfarin.…”

Pharmacological modulation of β-adrenoceptor function in patients with coexisting chronic obstructive pulmonary disease and chronic heart failure

“…A meta-analysis of 9 randomized clinical trials that lasted at least one year, with > 3,500 patients, found that when salmeterol was used instead of placebo or usual therapy, patients were less likely to withdraw early and suffer an exacerbation, and had a better health status and a greater increase in FEV 1 [27]. There was no tachyphylaxis or death reported although some papers M A N U S C R I P T [10,13,14]. In fact, numerous substrates for ventricular arrhythmia exist in these patients: hypoxia, acidosis, hypercapnia, sympathetic activation, tachycardia, hypokalaemia, and QTc prolongation secondary to inhaled β 2 -agonists [10,13].…”

“…There was no tachyphylaxis or death reported although some papers M A N U S C R I P T [10,13,14]. In fact, numerous substrates for ventricular arrhythmia exist in these patients: hypoxia, acidosis, hypercapnia, sympathetic activation, tachycardia, hypokalaemia, and QTc prolongation secondary to inhaled β 2 -agonists [10,13]. However, the TORCH (TOwards a Revolution in COPD Health) study [32], in which more than 6,000 patients with COPD were randomized to salmeterol, fluticasone, combination salmeterol-fluticasone, or placebo, documented that the overall mortality, cardiovascular mortality, and cardiovascular-related adverse events were no greater in the salmeterol group compared with any of the other groups.…”

“…Traditionally, the treatment of COPD is based on the use of long-acting bronchodilators, mainly long-acting β 2 -agonists (LABAs) and/or long-acting antimuscarinic agents, as well as the use of short-acting β-agonists (SABAs) as rescue medication, but it has been suggested that the use of β 2 -agonists might lead to an increased risk for adverse events in patients suffering from COPD [13] as well as in those suffering from CHF [10,14]. On the other hand, despite clear evidence of the effectiveness of β-blockers in the management of patients with CHF, the use of these agents has traditionally been contraindicated in COPD, mainly because of anecdotal evidence and case M A N U S C R I P T…”

Antileucotrienos no tratamento da asma e rinite alérgica

“…5 10 and a study called SMART, 11 in which they list the main controversial points about using LABA, mainly salmeterol, defending the benefits of associating LABA and IC. Since those data were obtained from adults, caution is required when using LABA in children before phase IV studies confirm their efficacy and cost-benefit advantage Therefore, there is still a predominance of arguments questioning the use of LABA in children, recently discussed in two articles 1,12 All these drug groups present a safety profile, usability, efficacy, effectiveness and actions on airway remodeling that allow adjustment both individually (LTA and IC) or in associations (LABA) ( Table 1).…”