Bronchodilator responsiveness in patients with chronic heart failure

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• 作者：Armine G. Minasian ; MD^a ; ^d ; ^{aminasian@rijnstate.nl} ; Frank J.J. van den Elshout ; MD ; PhD^a ; ^d ; ^{fvandenelshout@rijnstate.nl} ; P.N. Richard Dekhuijzen ; MD ; PhD^b ; ^e ; ^{R.Dekhuijzen@LONG.umcn.nl} ; Petra J.E. Vos ; MD ; PhD^a ; ^d ; ^{pvos@rijnstate.nl} ; Frank F. Willems ; MD ; PhD^c ; ^f ; ^{fwillems@rijnstate.nl} ; Paul J.P.C. van den Bergh ; MD^c ; ^f ; ^{pvandenbergh@rijnstate.nl} ; Yvonne F. Heijdra ; MD ; PhD^b ; ^e ; ^{Y.Heijdra@LONG.umcn.nl}
• 关键词：Chronic heart failure ; Bronchodilator responsiveness ; Salbutamol ; Ipratropium ; Airway obstruction
• 刊名：Heart Lung: The Journal of Acute and Critical Care
• 出版年：2013
• 出版时间：May-June, 2013
• 年：2013
• 卷：42
• 期：3
• 页码：208-214
• 全文大小：228 K

文摘

Objective

The aim of this study was to evaluate the effect of inhaled bronchodilators on pulmonary function and dyspnea in patients with chronic heart failure (HF).

Background

Conflicting data exist on whether bronchodilators may improve pulmonary function and dyspnea in patients with chronic HF.

Methods

In this retrospective observational study we analyzed data of 116 chronic HF outpatients with systolic dysfunction who underwent spirometry and Borg dyspnea measurements before and after inhalation of 400?¦Ìg salbutamol and 80?¦Ìg ipratropium. Patients with chronic obstructive pulmonary disease (COPD) or asthma were excluded.

Results

Bronchodilators fully reversed airway obstruction (AO) in 25 of 64 (39.1 % ) patients with pre-bronchodilator AO. All spirometric measurements, except for forced vital and inspiratory capacities, improved significantly post-bronchodilation. Absolute and percent improvements in forced expiratory volume in 1?s (FEV₁) were more pronounced in patients with persistent AO post-bronchodilation compared to those without AO (0.19?¡À?0.18?L and 8.4?¡À?7.3 % versus 0.11?¡À?0.12?L and 4.3?¡À?4.0 % , p?<?0.05). Significant bronchodilator responsiveness of FEV₁ (>200?mL and >12 % ) was noted in 12.1 % and was more frequent in patients with persistent AO and fully reversible AO than in those without AO (23.1 % and 16.0 % versus 1.9 % , p?<?0.05). We measured a small, albeit significant improvement in dyspnea (0.7 ¡À 1.2 versus 0.9 ¡À 1.3, p?=?0.002).

Conclusions

Inhaled bronchodilators may have an additional role in the management of patients with chronic HF because of their potential to improve pulmonary function, especially in those with AO. The clinical usefulness and possible adverse events of bronchodilators need to be further established.