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)

Research output: Contribution to journalArticle

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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 languageEnglish
Pages (from-to)785-792
Number of pages8
JournalQJM : an International Journal of Medicine
Volume110
Issue number12
Early online date24 Jul 2017
DOIs
Publication statusPublished - Dec 2017

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Bisoprolol
Chronic Obstructive Pulmonary Disease
Forced Expiratory Volume
Therapeutics
Lung Compliance
Lung
Muscarinic Antagonists
Vital Capacity
Cross-Over Studies
carvedilol
Adrenal Cortex Hormones
Cardiovascular Diseases
Heart Rate
Exercise

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.}",
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Cardiopulmonary interactions with beta-blockers and inhaled therapy in COPD. / Jabbal, S.; Anderson, W.; Short, P.; Morrison, A.; Manoharan, A.; Lipworth, B. J. (Lead / Corresponding author).

In: QJM : an International Journal of Medicine, Vol. 110, No. 12, 12.2017, p. 785-792.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Cardiopulmonary interactions with beta-blockers and inhaled therapy in COPD

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.

U2 - 10.1093/qjmed/hcx155

DO - 10.1093/qjmed/hcx155

M3 - Article

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EP - 792

JO - QJM : an International Journal of Medicine

JF - QJM : an International Journal of Medicine

SN - 1460-2725

IS - 12

ER -