β-Blockers in COPD: A Cohort Study From the TONADO Research Program

Chest: The Journal of Circulation, Respiration and Related Systems

Valeria C. Amatto^4¹  Lars Grönke^4²  François Maltais^1³  Ulrich Bothner^4⁴  Jim Reid^5⁵  Andrea Koch^3⁶  Roland Buhl^2⁷  Florian Voß^6⁸ 

[1] Boehringer Ingelheim International GmbH, Ingelheim, Germany^4;Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim, Germany^6;Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City, QC, Canada^1;Centre for Infection and Immunity, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, Northern Ireland^7;Dunedin School of Medicine, University of Otago, Dunedin, New Zealand^5;Medizinische Klinik und Poliklinik V, Klinikum der Ludwig-Maximilians-Universität, and the German Center for Lung Research (DZL), Klinikum der Ludwig-Maximilians-Universität, Munich, Germany^3;Pulmonary Department, Mainz University Hospital, Mainz, Germany^2;Pulmonary Research Institute of Southeast Michigan, Farmington Hills, MI^8

关键词: β-blockers;    COPD;    lung function;    safety;    AE;    adverse event;    GOLD;    Global Initiative for Chronic Obstructive Lung Disease;    SGRQ;    St. George’s Respiratory Questionnaire;   

DOI  :  10.1016/j.chest.2018.01.008

学科分类：呼吸医学

来源: American College of Chest Physicians

【 摘 要 】

Background Cardiovascular disease is a frequent comorbidity in patients with COPD. Many physicians, particularly pulmonologists, are reluctant to use β-adrenoceptor blocking agents (β-blockers) in patients with COPD, despite their proven effectiveness in preventing cardiovascular events. Methods The large (5,162 patients) phase III TONADO 1 and 2 studies assessed lung function and patient-reported outcomes in patients with moderate to very severe COPD receiving long-acting bronchodilator treatment across 1 year. This post hoc analysis characterized lung-function changes, patient-reported outcomes, and safety in the subgroup of patients receiving β-blockers in the studies. Results In total, 557 of 5,162 patients (11%) received β-blockers at baseline. Postbronchodilator FEV₁ at baseline was higher in the β-blocker group (1.470 L) compared with that in the no β-blocker group (1.362 L). As expected, patients receiving β-blockers had a more frequent history of cardiovascular comorbidities and medications. Lung function improved from baseline in patients with or those without β-blocker treatment, and no relevant between-group differences were observed in trough FEV₁ or trough FVC at 24 or 52 weeks. No relevant differences were observed for St. George's Respiratory Questionnaire results and Transition Dyspnea Index in patients with β-blockers compared with those in patients without. Safety findings were comparable between groups. Conclusions Lung function, overall respiratory status, and safety of tiotropium/olodaterol were not influenced by baseline β-blocker treatment in patients with moderate to very severe COPD. Results from this large patient cohort support the cautious and appropriate use of β-blockers in patients with COPD and cardiovascular comorbidity. Trial Registry ClinicalTrials.gov; No.: NCT01431274 and No. NCT01431287; URL: www.clinicaltrials.gov

【 授权许可】

CC BY