Russian Heart Failure Journal 2009year Carvedilol in the treatment of chronic heart failure with concomitant chronic obstructive lung disease: intolerance predictors


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2009/

Carvedilol in the treatment of chronic heart failure with concomitant chronic obstructive lung disease: intolerance predictors

Sitnikova M. Yu., Fedotov P. A., Shaporova N. L.

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Urgency. Combination of CHF and chronic obstructive lung disease (COLD) worsens prognosis of patients and complicates β-blocker therapy. Aim. Studying the effect of the non-selective β-blocker carvedilol on the COLD course and parameters of the broncho-pulmonary system during the treatment for CHF of ischemic origin and indentifying the factors associated with development of bronchospasm which limits the possibility of β-blocker titration to the optimum dose or results in β-blocker discontinuation. Materials and methods. Study enrolled 60 patients in stable condition with II-IV FC CHF of ischemic origin (LV EF <45%) in combination with II-III degree COLD. Study protocol included assessments of the clinical status, shortbreathing severity by the Borg scale, echoCG, and external respiratory function (ERF) at baseline and at 12 months. Patients were divided into 3 groups (20 patients in each group): Group 1 and Group 2 contained patients with CHF and COLD randomized by the presence or absence of carvedilol in the regimen of therapy for CHF; Group 3 included patients with CHF without COLD. All patients received a standard therapy for CHF, IHD and COLD for 12 months. Results. The therapy for CHF including carvedilol, independent on the presence or absence of COLD, reduced the CHF severity (CHF FC, heart rate, number and rate of repeated hospitalizations per year). The use of carvedilol in CHF patients with concomitant COLD was characterized with prolonged time to the response to β-blocker therapy. The therapy for CHF including carvedilol did not result in a significant aggravation of COLD or progression of the bronchoobstructive syndrome in most patients. Development of bronchospasm during the carvedilol treatment in CHF patients with concomitant COLD was predictable and associated with baseline postbronchodilatation FEV1 and a history of heavy smoking.
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