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Matera MG, Rogliani P, Calzetta L, Cazzola M. An overview of the efficacy and safety of β 2-adrenoceptor antagonists for the treatment of chronic obstructive pulmonary disease. Expert Opin Drug Saf 2024:1-12. [PMID: 38813912 DOI: 10.1080/14740338.2024.2362817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 05/29/2024] [Indexed: 05/31/2024]
Abstract
INTRODUCTION The safety of β2-AR antagonists in the treatment of patients with COPD continues to be a topic of research and discussion within the medical community. Emerging evidence suggests potentially benefits in the management of this complex respiratory condition. However, antagonists that display a preference for β2-AR over β1-AR present a complex therapeutic challenge in COPD management, necessitating an understanding of differences in their pharmacological profiles and clinical implications. AREAS COVERED An overview of the mechanisms of action of β2-AR antagonists and their potential impact on respiratory function, their pharmacological interactions, clinical implications, and future perspectives in COPD. EXPERT OPINION β-Blockers have the potential to become a versatile class of therapeutic agents with benefits beyond their original cardiovascular use. However, the one-size-fits-all approach of prescribing β-blockers regardless of their receptor selectivity to COPD patients with concomitant heart disease may not be appropriate. Instead, it is advisable to develop an individualized treatment strategy based on a thorough assessment of the patient's overall health. The use of non selective β2-AR antagonists, functioning as inverse agonists at β2-ARs, has garnered interest and debate, but further research efforts should focus on elucidating the optimal use of β-AR antagonists in COPD, balancing cardiovascular benefits with potential respiratory risks to enhance outcomes and quality of life for individuals living with this debilitating respiratory condition.
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Affiliation(s)
- Maria Gabriella Matera
- Unit of Pharmacology, Department of Experimental Medicine, School of Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Paola Rogliani
- Unit of Respiratory Medicine, Department Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Luigino Calzetta
- Unit of Respiratory Disease and Lung Function, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Mario Cazzola
- Unit of Respiratory Medicine, Department Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
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Matera MG, Calzetta L, Rogliani P, Hanania N, Cazzola M. Cardiovascular Events with the Use of Long-Acting Muscarinic Receptor Antagonists: An Analysis of the FAERS Database 2020-2023. Lung 2024; 202:119-125. [PMID: 38321329 PMCID: PMC11009752 DOI: 10.1007/s00408-024-00677-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 01/31/2024] [Indexed: 02/08/2024]
Abstract
PURPOSE This study aimed to examine reports of cardiovascular adverse events (CV AEs) observed in the real-world during treatment with aclidinium, tiotropium, glycopyrronium, and umeclidinium alone or in combination with a LABA and, in the context of triple therapy, with the addition of an ICS, and submitted to the food and drug administration adverse event reporting system (FAERS). METHODS A retrospective disproportionality analysis was conducted utilizing CV AE reports submitted to the FAERS from January 2020 to 30 September 2023. Disproportionality was measured by calculating the reporting odds ratio. RESULTS Compared with ipratropium, tiotropium was associated with fewer reports of CV AEs. Compared with tiotropium, other LAMAs were more likely to be associated with reports of CV AEs. Combinations of glycopyrronium with indacaterol or formoterol and umeclidinium with vilanterol significantly reduced reports of CV AEs compared with the respective LAMA. The addition of an ICS to these combinations further reduced the risk of CV AE reports. CONCLUSION Our study suggests that inhaled LAMAs are not free from cardiac AE risks. This risk may be more evident when the newer LAMAs are used, but it is generally significantly reduced when COPD patients are treated with dual bronchodilators or triple therapy. However, these results do not prove that LAMAs cause CV AEs, as FAERS data alone are not indicative of a drug's safety profile. Given the frequency with which COPD and cardiovascular disease co-exist, a large study in the general population could shed light on this very important issue.
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Affiliation(s)
- Maria Gabriella Matera
- Unit of Pharmacology, Department of Experimental Medicine, School of Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Luigino Calzetta
- Unit of Respiratory Disease and Lung Function, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Paola Rogliani
- Unit of Respiratory Medicine, Department Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Nicola Hanania
- Section of Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Mario Cazzola
- Unit of Respiratory Medicine, Department Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy.
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Matera MG, Rinaldi B, Calzetta L, Rogliani P, Cazzola M. Advances in adrenergic receptors for the treatment of chronic obstructive pulmonary disease: 2023 update. Expert Opin Pharmacother 2023; 24:2133-2142. [PMID: 37955136 DOI: 10.1080/14656566.2023.2282673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 11/08/2023] [Indexed: 11/14/2023]
Abstract
INTRODUCTION Strong scientific evidence and large experience support the use of β2-agonists for the symptomatic alleviation of COPD. Therefore, there is considerable effort in discovering highly potent and selective β2-agonists. AREAS COVERED Recent research on novel β2-agonists for the treatment of COPD. A detailed literature search was performed in two major databases (PubMed/MEDLINE and Scopus) up to September 2023." EXPERT OPINION Compounds that preferentially activate a Gs- or β-arrestin-mediated signaling pathway via β- adrenoceptors (ARs) are more innovative. Pepducins, which target the intracellular region of β2-AR to modulate receptor signaling output, have the most interesting profile from a pharmacological point of view. They stabilize the conformation of the β2-AR and influence its signaling by interacting with the intracellular receptor-G protein interface. New bifunctional drugs called muscarinic antagonist-β2 agonist (MABA), which have both muscarinic receptor (mAChR) antagonism and β2-agonist activity in the same molecule, are a new opportunity. However, all tested compounds have been shown to act predominantly as mAChR antagonists or β2-agonists. An intriguing idea is to utilize allosteric modulators that bind to β2-ARs at sites different than those bound by orthosteric ligands to augment or reduce the signaling transduced by the orthosteric ligand.
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Affiliation(s)
- Maria Gabriella Matera
- Unit of Pharmacology, Department of Experimental Medicine, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Barbara Rinaldi
- Unit of Pharmacology, Department of Experimental Medicine, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Luigino Calzetta
- Unit of Respiratory Diseases and Lung Function, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Paola Rogliani
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome 'Tor Vergata', Rome, Italy
| | - Mario Cazzola
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome 'Tor Vergata', Rome, Italy
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Chaulin AM, Duplyakov DV. Comorbidity in chronic obstructive pulmonary disease and cardiovascular disease. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2021. [DOI: 10.15829/1728-8800-2021-2539] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Comorbidity is one of the most significant problems of modern healthcare. Numerous studies have analyzed the possible pathogenetic mechanisms and relationships between a wide variety of diseases. Cardiovascular (CVD) and pulmonary diseases, in particular chronic obstructive pulmonary disease (COPD), have a number of the same risk factors and pathogenetic links, which aggravate each other's course. Moreover, CVD and COPD are among the most common diseases in the world. This review provides up-to-date information on the prevalence, risk factors and pathophysiological mechanisms underlying this unfavorable combination of diseases. Some problems of diagnosis and treatment of patients with COPD and CVD are also discussed.
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Affiliation(s)
- A. M. Chaulin
- Samara Regional Clinical Cardiology Dispensary; Samara State Medical University
| | - D. V. Duplyakov
- Samara Regional Clinical Cardiology Dispensary; Samara State Medical University
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Rogliani P, Ritondo BL, Laitano R, Chetta A, Calzetta L. Advances in understanding of mechanisms related to increased cardiovascular risk in COPD. Expert Rev Respir Med 2020; 15:59-70. [PMID: 33084434 DOI: 10.1080/17476348.2021.1840982] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Chronic obstructive pulmonary disease (COPD) represents a serious global health issue that is commonly associated with cardiovascular (CV) disease (CVD). The close relationship between COPD and CVD could be explained by different factors, first and foremost a chronic low-grade systemic inflammation implicated in the pathogenesis of both diseases and several stimuli enhancing the inflammatory processes and causing a mixed condition with worse outcomes than either disorder alone. AREAS COVERED The present narrative review considers the mechanisms underlying the increased CV risk in COPD, and it provides insights on biomarkers and predictive models to predict CVD in COPD patients. EXPERT OPINION COPD patients often remain asymptomatic of CVD, with respiratory symptoms generally attributed to the preexisting pulmonary disease. It is fundamental to understand the mechanistic pathways that underpin the intimate relationship between the two disorders. However, it is still not clear what is the origin of the common background of low-grade systemic inflammation, it could be a 'spillover' or a general inflammatory state. Primary prevention, cross-collaboration between specialists and early detection via predictive biomarkers and validated models are fundamental to stratify COPD patients according to CV risk.
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Affiliation(s)
- Paola Rogliani
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome "Tor Vergata" , Rome, Italy
| | - Beatrice Ludovica Ritondo
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome "Tor Vergata" , Rome, Italy
| | - Rossella Laitano
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome "Tor Vergata" , Rome, Italy
| | - Alfredo Chetta
- Department of Medicine and Surgery, Respiratory Disease and Lung Function Unit, University of Parma , Parma, Italy
| | - Luigino Calzetta
- Department of Medicine and Surgery, Respiratory Disease and Lung Function Unit, University of Parma , Parma, Italy
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Andreas S, Bothner U, de la Hoz A, Kloer I, Trampisch M, Alter P. A Post Hoc Holter ECG Analysis of Olodaterol and Formoterol in Moderate-to-Very-Severe COPD. Int J Chron Obstruct Pulmon Dis 2020; 15:1955-1965. [PMID: 32848381 PMCID: PMC7428408 DOI: 10.2147/copd.s246353] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 07/15/2020] [Indexed: 12/13/2022] Open
Abstract
Background Patients with chronic obstructive pulmonary disease (COPD) are at risk of developing cardiac arrhythmias and elevated heart rate. A theoretical mechanistic association based on the interaction of long-acting β2-agonists (LABAs) with adrenoreceptors in the heart and vasculature is assumed as a potential class-related risk. Therefore, we performed a pooled analysis of Holter electrocardiogram (ECG) data from four 48-week, randomized, double-blind, placebo-controlled, parallel-group, Phase III clinical trials evaluating olodaterol (5 μg or 10 μg) or formoterol (12 µg) versus placebo. Methods We analyzed Holter ECG data from a representative subset of 775 patients with Global Initiative for Chronic Obstructive Lung Disease stage 2–4 COPD from four studies (1222.11–14) assessing olodaterol (5 μg and 10 μg) and formoterol (12 µg) versus placebo. Results No statistically significant (P>0.3) or clinically relevant differences in the shift from baseline of premature supraventricular or ventricular beats were observed among the active treatment and the placebo groups. Minor and transient differences were observed in the adjusted mean heart rate from baseline during treatment in all groups. There was a numerically small but statistically significant increase for formoterol at Week 24, olodaterol 5 μg at Weeks 12 and 40, and olodaterol 10 μg at Week 40 (all less than 3.0 beats per minute). Mean heart rates returned to a statistically non-significant change at Week 48 for all treatment groups. No increase in major adverse cardiovascular events was observed. Conclusion Treatment with olodaterol or formoterol is not associated with arrhythmias or a persistent increase in heart rate as assessed by Holter ECG in patients with COPD. Trial Registration ClinicalTrials.gov identifiers: NCT00782210 (1222.11); NCT00782509 (1222.12); NCT00793624 (1222.13); NCT00796653 (1222.14).
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Affiliation(s)
- Stefan Andreas
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Göttingen, Germany.,LungClinic Immenhausen, Immenhausen, Germany, Member of the German Center for Lung Research (DZL)
| | - Ulrich Bothner
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | - Alberto de la Hoz
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | - Isabel Kloer
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | | | - Peter Alter
- Department of Medicine, Pulmonary and Critical Care Medicine, Philipps University of Marburg (UMR), Marburg, Germany, Member of the German Center for Lung Research (DZL)
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COMBORIDITY OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE AND CARDIOVASCULAR DISEASES: GENERAL FACTORS, PATHOPHYSIOLOGICAL MECHANISMS AND CLINICAL SIGNIFICANCE. КЛИНИЧЕСКАЯ ПРАКТИКА 2020. [DOI: 10.17816/clinpract21218] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Currently, the comorbidity (combination) of chronic obstructive pulmonary disease (COPD) and cardiovascular diseases (CVD) is an relevant problem for health care. This is due to the high prevalence and continued growth of these pathologies. CVD and COPD have common risk factors and mechanisms underlying their development and progression: smoking, inflammation, sedentary lifestyle, aging, oxidative stress, air pollution, and hypoxia.
In this review, we summarize current knowledge relating to the prevalence and frequency of cardiovascular diseases in people with COPD and the mechanisms that underlie their coexistence. The implications for clinical practice, in particular the main problems of diagnosis and treatment of COPD/CVD comorbidity, are also discussed.
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André S, Conde B, Fragoso E, Boléo-Tomé JP, Areias V, Cardoso J. COPD and Cardiovascular Disease. Pulmonology 2018; 25:168-176. [PMID: 30527374 DOI: 10.1016/j.pulmoe.2018.09.006] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Accepted: 09/20/2018] [Indexed: 01/19/2023] Open
Abstract
COPD is one of the major public health problems in people aged 40 years or above. It is currently the 4th leading cause of death in the world and projected to be the 3rd leading cause of death by 2020. COPD and cardiac comorbidities are frequently associated. They share common risk factors, pathophysiological processes, signs and symptoms, and act synergistically as negative prognostic factors. Cardiac disease includes a broad spectrum of entities with distinct pathophysiology, treatment and prognosis. From an epidemiological point of view, patients with COPD are particularly vulnerable to cardiac disease. Indeed, mortality due to cardiac disease in patients with moderate COPD is higher than mortality related to respiratory failure. Guidelines reinforce that the control of comorbidities in COPD has a clear benefit over the potential risk associated with the majority of the drugs utilized. On the other hand, the true survival benefits of aggressive treatment of cardiac disease and COPD in patients with both conditions have still not been clarified. Given their relevance in terms of prevalence and prognosis, we will focus in this paper on the management of COPD patients with ischemic coronary disease, heart failure and dysrhythmia.
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Affiliation(s)
- S André
- Pulmonology Department, Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, EPE (CHLO), Lisbon, Portugal
| | - B Conde
- Pulmonology Department, Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - E Fragoso
- Pulmonology Department, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, EPE (CHLN), Lisbon, Portugal
| | - J P Boléo-Tomé
- Pulmonology Department, Hospital Prof. Doutor Fernando Fonseca, EPE, Amadora, Portugal
| | - V Areias
- Pulmonology Department, Hospital de Faro, Centro Hospitalar do Algarve, EPE, Faro, Portugal; Department of Biomedical Sciences and Medicine, Algarve University, Portugal
| | - J Cardoso
- Pulmonology Department, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, EPE (CHLC), Lisbon, Portugal; Nova Medical School, Nova University, Lisbon, Portugal.
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Rogliani P, Brusasco V, Fabbri L, Ungar A, Muscianisi E, Barisone I, Corsini A, De Angelis G. Multidimensional approach for the proper management of a complex chronic patient with chronic obstructive pulmonary disease. Expert Rev Respir Med 2017; 12:103-112. [PMID: 29241393 DOI: 10.1080/17476348.2018.1417041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Chronic obstructive pulmonary disease (COPD) is frequently associated with comorbidities occurring either independently or as consequences of COPD. Areas covered: This review examines the interactions between the pathophysiology of COPD and the most frequent comorbidities, and highlights the need for multidimensional clinical strategies to manage COPD patients with comorbidities. Expert commentary: Most COPD patients need to be approached in a complex and multifactorial scenario. The diagnosis of COPD is necessarily based on the presence of chronic respiratory symptoms and poorly reversible airflow obstruction, but exacerbations and comorbidities need to be considered in the evaluation of disease severity and prognosis in individual patients. More importantly, defining the precise relationship between COPD and comorbidities for each patient is the basis for a correct therapeutic approach.
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Affiliation(s)
- Paola Rogliani
- a Department of Experimental Medicine and Surgery , University of Rome "Tor Vergata" , Rome , Italy
| | - Vito Brusasco
- b Department of Internal Medicine , University of Genoa , Genova , Italy
| | - Leonardo Fabbri
- c Department of Endocrinology, Metabolism and Geriatric , Sant'Agostino Hospital , Modena , Italy
| | - Andrea Ungar
- d Geriatric and Intensive Care Medicine , AO Careggi and University of Florence , Florence , Italy
| | - Elisa Muscianisi
- e Novartis Farma Spa, Respiratory Franchise , Origgio , VA , Italy
| | - Ilaria Barisone
- e Novartis Farma Spa, Respiratory Franchise , Origgio , VA , Italy
| | - Alberto Corsini
- f Department of Pharmacological and Biomolecular Sciences , University of Milan , Milan , Italy.,g Multimedica IRCCS , Milan Italy
| | - Giuseppe De Angelis
- h Department of Cardiovascular Medicine , University of Milan , Milan , Italy
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Cazzola M, Rogliani P, Puxeddu E, Ora J, Matera MG. An overview of the current management of chronic obstructive pulmonary disease: can we go beyond the GOLD recommendations? Expert Rev Respir Med 2017; 12:43-54. [DOI: 10.1080/17476348.2018.1398086] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Mario Cazzola
- Department of Systems Medicine, Chair of Respiratory Medicine, University of Rome “Tor Vergata”, Rome, Italy
| | - Paola Rogliani
- Department of Systems Medicine, Chair of Respiratory Medicine, University of Rome “Tor Vergata”, Rome, Italy
- Division of Respiratory Medicine, Department of Internal Medicine, University Hospital “Tor Vergata”, Rome, Italy
| | - Ermanno Puxeddu
- Department of Systems Medicine, Chair of Respiratory Medicine, University of Rome “Tor Vergata”, Rome, Italy
- Division of Respiratory Medicine, Department of Internal Medicine, University Hospital “Tor Vergata”, Rome, Italy
| | - Josuel Ora
- Division of Respiratory Medicine, Department of Internal Medicine, University Hospital “Tor Vergata”, Rome, Italy
| | - Maria Gabriella Matera
- Department of Experimental Medicine, Unit of Pharmacology, University of Campania “Luigi Vanvitelli”, Naples, Italy
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Management of Chronic Obstructive Pulmonary Disease in Patients with Cardiovascular Diseases. Drugs 2017; 77:721-732. [DOI: 10.1007/s40265-017-0731-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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El-Shabrawy M, Eldamanhory AS. Study of cardiovascular diseases in hospitalized AECOPD patients. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2017. [DOI: 10.1016/j.ejcdt.2016.08.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Zhang L, Yuan QY. Vitamin D should be supplemented more actively in elderly patients with coronary heart disease combined with COPD. Int J Chron Obstruct Pulmon Dis 2016; 11:1359-65. [PMID: 27382272 PMCID: PMC4922805 DOI: 10.2147/copd.s105671] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Objective It is not clear whether vitamin D should be actively supplemented in elderly patients suffering from an acute attack of COPD (AECOPD) and coronary heart disease (CHD). Patients and methods The patients were divided into three groups according to specific criteria: patients with AECOPD (group A), patients with COPD combined with CHD (group B), and patients with CHD (group C). We measured the levels of vitamin D and analyzed the correlation between vitamin D and important electrolytes, including prealbumin, creatinine, hemoglobin, cystatin C, blood fat, blood calcium, and blood magnesium, and the nutrition state of the whole body. The serum B-type natriuretic peptide (BNP) was measured using an ELISA kit. Results The vitamin D level in group B was the lowest, followed by group A. When compared with group C, they all had statistical significance (P<0.05), but there was no statistical difference between groups A and B. There was no difference among the three groups when prealbumin, creatinine, hemoglobin, cystatin C, blood fat, blood calcium, and blood magnesium were compared. The level of BNP in the three groups increased, but it had no obvious correlation with the level of vitamin D (P>0.05). Conclusion When elderly patients have coronary artery disease with AECOPD, vitamin D levels were obviously lower and were negatively correlated with the BNP. Low vitamin D levels, as well as poor nutrition, affect cardiopulmonary function and quality of living of elderly patients, especially female patients. Therefore, vitamin D should be supplemented more actively in the female patients suffering from AECOPD and CHD.
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Affiliation(s)
| | - Qiao-Ying Yuan
- Department of Nutriology, Southwest Hospital, The Third Military Medical University, Chongqing, People's Republic of China
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Cazzola M, Rogliani P, Ora J, Matera MG. Treatment options for moderate-to-very severe chronic obstructive pulmonary disease. Expert Opin Pharmacother 2016; 17:977-88. [PMID: 26894516 DOI: 10.1517/14656566.2016.1155555] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
INTRODUCTION The appropriate drug management of COPD is still based on the use of bronchodilators, possibly associated with an anti-inflammatory agent. However, there are still fundamental questions that require clarification to optimise their use and major unmet clinical needs that must be addressed. AREAS COVERED The advances obtained with the pharmacological options currently consolidated and the different approaches that are often used in an attempt to respond to unmet therapeutic needs are reviewed Expert opinion: In view of the unsatisfactory status of current treatments for COPD, there is an urgent need for alternative and more effective therapeutic approaches that will help to relieve patient symptoms and affect the natural course of COPD, inhibiting chronic inflammation and reversing the disease process or preventing its progression. However, new pharmacologic options have proved difficult to develop. Therefore, it is mandatory to optimize the use of the treatment options at our disposal. However, there are still fundamental questions regarding their use, including the step-up and step-down pharmacological approach, that require clarification to optimise the use of these drugs. It is likely that phenotyping COPD patients would help in identifying the right treatment for each COPD patient and improve the effectiveness of therapies.
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Affiliation(s)
- Mario Cazzola
- a Department of Systems Medicine , University of Rome Tor Vergata , Rome , Italy
| | - Paola Rogliani
- a Department of Systems Medicine , University of Rome Tor Vergata , Rome , Italy
| | - Josuel Ora
- a Department of Systems Medicine , University of Rome Tor Vergata , Rome , Italy
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