Pulmonary and cardiac drugs: clinically relevant interactions

Abstract

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 1 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.

Comprehensive care for people living with heart failure and chronic obstructive pulmonary disease—Integration of palliative care with disease-specific care: From guidelines to practice

“…The only exception among NSAIDs is acetylsalicylic acid (ASA), used at a dose of 75–100 mg/day as secondary prophylaxis in atherosclerosis (i.e., coronary artery disease). There are not known specific contraindications for their use in people with COPD, but administration of NSAIDs, including ASA, has been shown to increase risk of new atrial fibrillation or bleeding ( 37 , 38 ). The randomized ENABLE-CHF-PC trial has shown that PC telehealth significantly improves pain intensity and its interference with daily life, but not QoL or mood ( 39 ).…”

Recent Advances in β2-Agonists for Treatment of Chronic Respiratory Diseases and Heart Failure

“…COPD and HF often coexist, as they share common risk factors, for instance aging and cigarette smoking. Overlap of COPD and HF occurs in about 30% (with a range from 8% to 52%) of patients suffering from either of the diseases. , β-Blockers and β 2 -agonists are the cornerstones of therapies for HF and COPD, respectively. As the actions of these two classes of drugs dramatically oppose each other, their use in patients with COPD-HF overlap has raised a number of concerns.…”

“…A possible cause of the cardiovascular adverse effects associated with the use of β 2 -agonists is off-target stimulation of the cardiac β 1 AR. As cardioselective β-blockers can ameliorate the cardiovascular adverse effects caused by inhaled β 2 -agonists while not causing bronchospasm, combining a β 2 -agonist with a selective β 1 -blocker has a good rationale for use in COPD-HF overlap . Future studies should focus on the analysis of the cardiovascular risks with different drug combinations.…”