Cardiopulmonary interactions with beta-blockers and inhaled therapy in COPD

S. Jabbal; W. Anderson; P. Short; A. Morrison; A. Manoharan; B. J. Lipworth

doi:10.1093/qjmed/hcx155

Cardiopulmonary interactions with beta-blockers and inhaled therapy in COPD

S. Jabbal, W. Anderson, P. Short, A. Morrison, A. Manoharan, B. J. Lipworth (Lead / Corresponding author)

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Abstract

Background: Beta-blockers remain underused in patients with COPD and cardiovascular disease. Aim: We compared how different inhaled therapies affect tolerability of bisoprolol and carvedilol in moderate to severe COPD. Design: A randomized, open label, cross-over study. Methods: We compared the cardiopulmonary interactions of bisoprolol 5mg qd or carvedilol 12·5 mg bid for 6 weeks in conjunction with: (a) triple: inhaled corticosteroid /long acting beta-agonist/long acting muscarinic antagonist (ICS+LABA+LAMA), (b) dual: ICS+LABA, (c) ICS alone. Results:18 patients completed, all ex-smokers, mean age 65 years, forced expiratory volume in 1 second (FEV1) 52% predicted. Bisoprolol and carvedilol produced comparable significant reduction in resting and exercise heart rate. FEV1, forced vital capacity (FVC) and lung compliance (AX) were significantly lower with carvedilol vs bisoprolol while taking concomitant ICS/LABA (P<0·05) but not ICS/LABA/LAMA. Conclusions: In summary, bisoprolol was better tolerated than carvedilol on pulmonary function at doses which produced equivalent cardiac beta-1 blockade. Worsening of pulmonary function with carvedilol was mitigated by concomitant inhaled LAMA (tiotropium) with LABA (formoterol), but not LABA alone.

Original language	English
Pages (from-to)	785-792
Number of pages	8
Journal	QJM : an International Journal of Medicine
Volume	110
Issue number	12
Early online date	24 Jul 2017
DOIs	https://doi.org/10.1093/qjmed/hcx155
Publication status	Published - Dec 2017

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Author Accepted Manuscript
This is a pre-copyedited, author-produced version of an article accepted for publication in QJM: an International Journal of Medicine following peer review. The version of record S. Jabbal, W. Anderson, P. Short, A. Morrison, A. Manoharan, B.J. Lipworth; Cardiopulmonary interactions with beta-blockers and inhaled therapy in COPD, QJM: An International Journal of Medicine, , hcx155 is available online at: https://doi.org/10.1093/qjmed/hcx155
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Cite this

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title = "Cardiopulmonary interactions with beta-blockers and inhaled therapy in COPD",

abstract = "Background: Beta-blockers remain underused in patients with COPD and cardiovascular disease. Aim: We compared how different inhaled therapies affect tolerability of bisoprolol and carvedilol in moderate to severe COPD. Design: A randomized, open label, cross-over study. Methods: We compared the cardiopulmonary interactions of bisoprolol 5mg qd or carvedilol 12·5 mg bid for 6 weeks in conjunction with: (a) triple: inhaled corticosteroid /long acting beta-agonist/long acting muscarinic antagonist (ICS+LABA+LAMA), (b) dual: ICS+LABA, (c) ICS alone. Results:18 patients completed, all ex-smokers, mean age 65 years, forced expiratory volume in 1 second (FEV1) 52% predicted. Bisoprolol and carvedilol produced comparable significant reduction in resting and exercise heart rate. FEV1, forced vital capacity (FVC) and lung compliance (AX) were significantly lower with carvedilol vs bisoprolol while taking concomitant ICS/LABA (P<0·05) but not ICS/LABA/LAMA. Conclusions: In summary, bisoprolol was better tolerated than carvedilol on pulmonary function at doses which produced equivalent cardiac beta-1 blockade. Worsening of pulmonary function with carvedilol was mitigated by concomitant inhaled LAMA (tiotropium) with LABA (formoterol), but not LABA alone. ",

author = "S. Jabbal and W. Anderson and P. Short and A. Morrison and A. Manoharan and Lipworth, {B. J.}",

note = "We would like to thank the Immunoassay Biomarker Core Lab, University of Dundee for sample analysis. The study was partially funded by TENOVUS Scotland (Grant No. T12/28) as well as from existing departmental unrestricted grant funds.",

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AU - Jabbal, S.

AU - Anderson, W.

AU - Short, P.

AU - Morrison, A.

AU - Manoharan, A.

AU - Lipworth, B. J.

N1 - We would like to thank the Immunoassay Biomarker Core Lab, University of Dundee for sample analysis. The study was partially funded by TENOVUS Scotland (Grant No. T12/28) as well as from existing departmental unrestricted grant funds.

PY - 2017/12

Y1 - 2017/12

N2 - Background: Beta-blockers remain underused in patients with COPD and cardiovascular disease. Aim: We compared how different inhaled therapies affect tolerability of bisoprolol and carvedilol in moderate to severe COPD. Design: A randomized, open label, cross-over study. Methods: We compared the cardiopulmonary interactions of bisoprolol 5mg qd or carvedilol 12·5 mg bid for 6 weeks in conjunction with: (a) triple: inhaled corticosteroid /long acting beta-agonist/long acting muscarinic antagonist (ICS+LABA+LAMA), (b) dual: ICS+LABA, (c) ICS alone. Results:18 patients completed, all ex-smokers, mean age 65 years, forced expiratory volume in 1 second (FEV1) 52% predicted. Bisoprolol and carvedilol produced comparable significant reduction in resting and exercise heart rate. FEV1, forced vital capacity (FVC) and lung compliance (AX) were significantly lower with carvedilol vs bisoprolol while taking concomitant ICS/LABA (P<0·05) but not ICS/LABA/LAMA. Conclusions: In summary, bisoprolol was better tolerated than carvedilol on pulmonary function at doses which produced equivalent cardiac beta-1 blockade. Worsening of pulmonary function with carvedilol was mitigated by concomitant inhaled LAMA (tiotropium) with LABA (formoterol), but not LABA alone.

AB - Background: Beta-blockers remain underused in patients with COPD and cardiovascular disease. Aim: We compared how different inhaled therapies affect tolerability of bisoprolol and carvedilol in moderate to severe COPD. Design: A randomized, open label, cross-over study. Methods: We compared the cardiopulmonary interactions of bisoprolol 5mg qd or carvedilol 12·5 mg bid for 6 weeks in conjunction with: (a) triple: inhaled corticosteroid /long acting beta-agonist/long acting muscarinic antagonist (ICS+LABA+LAMA), (b) dual: ICS+LABA, (c) ICS alone. Results:18 patients completed, all ex-smokers, mean age 65 years, forced expiratory volume in 1 second (FEV1) 52% predicted. Bisoprolol and carvedilol produced comparable significant reduction in resting and exercise heart rate. FEV1, forced vital capacity (FVC) and lung compliance (AX) were significantly lower with carvedilol vs bisoprolol while taking concomitant ICS/LABA (P<0·05) but not ICS/LABA/LAMA. Conclusions: In summary, bisoprolol was better tolerated than carvedilol on pulmonary function at doses which produced equivalent cardiac beta-1 blockade. Worsening of pulmonary function with carvedilol was mitigated by concomitant inhaled LAMA (tiotropium) with LABA (formoterol), but not LABA alone.

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JO - QJM : an International Journal of Medicine

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Cardiopulmonary interactions with beta-blockers and inhaled therapy in COPD

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