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Lin CH, Yeh JK, Lin TY, Lo YL, Chang BJ, Ju JS, Chiu TH, Tung PH, Huang YJ, Lin SM. Influence of chronic obstructive pulmonary disease on long-term hospitalization and mortality in patients with heart failure with reduced ejection fraction. BMC Pulm Med 2023; 23:67. [PMID: 36805703 PMCID: PMC9936736 DOI: 10.1186/s12890-023-02357-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 02/07/2023] [Indexed: 02/19/2023] Open
Abstract
BACKGROUND Heart failure with reduced ejection fraction (HFrEF) can coexist with chronic obstructive pulmonary disease (COPD), which complicates the clinical situation and worsens quality of life. The study used standard diagnostic criteria for detecting COPD in hospitalized HFrEF patients and to survey the influence of other comorbidities and medications on the long-term outcomes of HFrEF + COPD patients. METHODS We retrospectively recruited patients hospitalized due to HFrEF in a tertiary medical center and examined and followed up clinical outcomes, including length of hospital stay, mortality, and readmission episodes, for a 5-year period. Risk factors for mortality were analyzed using multivariate analysis. RESULTS Of the 118 hospitalized HFrEF study participants, 68 had concurrent COPD whereas 50 did not. There was a significant increase in the male predominance, smoking history, higher hemoglobin level and increased length of hospital stay in the HF + COPD group than in the HF-only group. Lower left ventricular ejection fraction was found in the HF and COPD comorbidity group. In multivariate analysis, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (ACEI/ARB) use independently associated with a beneficial effect on survival in HF patients with COPD. Oral corticosteroid uses and stroke as a comorbidity were independently associated with a shorter time to the first readmission episode. CONCLUSION In HFrEF patients, COPD was associated with a prolonged length of hospital stay. ACEI/ARB use might relate to a beneficial effect on survival in HF patients with COPD. The use of maintenance oral corticosteroid in patients with both HF and COPD should be crucially evaluated to determine the clinical benefit and disadvantages.
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Affiliation(s)
- Chiung-Hung Lin
- grid.145695.a0000 0004 1798 0922Department of Thoracic Medicine, School of Medicine, Chang Gung Memorial Hospital, Chang Gung University, 199 Tun-Hwa N. Rd., Taipei, Taiwan
| | - Jih-Kai Yeh
- grid.454211.70000 0004 1756 999XDepartment of Cardiology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ting-Yu Lin
- grid.145695.a0000 0004 1798 0922Department of Thoracic Medicine, School of Medicine, Chang Gung Memorial Hospital, Chang Gung University, 199 Tun-Hwa N. Rd., Taipei, Taiwan
| | - Yu-Lun Lo
- grid.145695.a0000 0004 1798 0922Department of Thoracic Medicine, School of Medicine, Chang Gung Memorial Hospital, Chang Gung University, 199 Tun-Hwa N. Rd., Taipei, Taiwan
| | - Bo-Jui Chang
- grid.145695.a0000 0004 1798 0922Department of Thoracic Medicine, School of Medicine, Chang Gung Memorial Hospital, Chang Gung University, 199 Tun-Hwa N. Rd., Taipei, Taiwan
| | - Jia-Shiuan Ju
- grid.145695.a0000 0004 1798 0922Department of Thoracic Medicine, School of Medicine, Chang Gung Memorial Hospital, Chang Gung University, 199 Tun-Hwa N. Rd., Taipei, Taiwan
| | - Tzu-Hsuan Chiu
- grid.145695.a0000 0004 1798 0922Department of Thoracic Medicine, School of Medicine, Chang Gung Memorial Hospital, Chang Gung University, 199 Tun-Hwa N. Rd., Taipei, Taiwan
| | - Pi-Hung Tung
- grid.145695.a0000 0004 1798 0922Department of Thoracic Medicine, School of Medicine, Chang Gung Memorial Hospital, Chang Gung University, 199 Tun-Hwa N. Rd., Taipei, Taiwan
| | - Yun-Ju Huang
- grid.454211.70000 0004 1756 999XDepartment of Rheumatology and Immunology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Shu-Min Lin
- Department of Thoracic Medicine, School of Medicine, Chang Gung Memorial Hospital, Chang Gung University, 199 Tun-Hwa N. Rd., Taipei, Taiwan. .,Department of Respiratory Therapy, School of Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan.
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Muraki M, Kunita Y, Shirahase K, Yamazaki R, Hanada S, Sawaguchi H, Tohda Y. A randomized controlled trial of long-acting muscarinic antagonist and long-acting β2 agonist fixed-dose combinations in patients with chronic obstructive pulmonary disease. BMC Pulm Med 2021; 21:26. [PMID: 33441146 PMCID: PMC7805049 DOI: 10.1186/s12890-021-01403-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 01/05/2021] [Indexed: 12/18/2022] Open
Abstract
Background In chronic obstructive pulmonary disease (COPD) patients, combination treatment with long-acting muscarinic antagonist (LAMA) and long-acting β2 agonist (LABA) increases forced expiratory volume in one second and reduces symptoms compared to monotherapy. In Japan, three different once-daily fixed-dose combinations (FDCs) have been prescribed since 2015, although a direct comparison of these FDCs has never been performed. The objective of the present study was to compare the effectiveness, preference, and safety of three LAMA/LABA FDCs—glycopyrronium/indacaterol (Gly/Ind), umeclidinium/vilanterol (Ume/Vil), and tiotropium/olodaterol (Tio/Olo)—in patients with COPD. Methods We enrolled 75 COPD outpatients (male:female ratio, 69:6; 77.4 ± 6.9 years). A prospective, randomized, crossover study was conducted on three groups using three FDCs: Gly/Ind; Ume/Vil; and Tio/Olo. Each medication was administered for 4 weeks before crossover (total 12 weeks). After each FDC administration, a respiratory function test and questionnaire survey were conducted. A comparative questionnaire survey of all three LAMA/LABA FDCs was conducted after 12 weeks (following administration of final FDC). Results No significant differences in COPD Assessment Test or modified Medical Research Council dyspnea questionnaire were reported in the surveys completed after each FDC administration; no significant differences in spirometric items were observed. In the final comparative questionnaire survey, patients reported better actual feeling of being able to inhale following Gly/Ind administration compared with Tio/Olo, although no significant differences in adverse events or other evaluations were reported. Conclusions The three LAMA/LABA FDCs administered to COPD patients show similar effects and safety, although some minor individual preference was reported. Trial registration This study retrospectively registered with the University Hospital Medical Information Network Clinical Trials Registry (number UMIN000041342, registered on August 6, 2020).
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Affiliation(s)
- Masato Muraki
- Department of Respiratory Medicine and Allergology, Kindai University Nara Hospital, 1248-1 Otoda-cho, Ikoma, Nara, 630-0293, Japan.
| | - Yuki Kunita
- Department of Respiratory Medicine and Allergology, Kindai University Nara Hospital, 1248-1 Otoda-cho, Ikoma, Nara, 630-0293, Japan
| | - Ken Shirahase
- Department of Respiratory Medicine and Allergology, Kindai University Nara Hospital, 1248-1 Otoda-cho, Ikoma, Nara, 630-0293, Japan
| | - Ryo Yamazaki
- Department of Respiratory Medicine and Allergology, Kindai University Nara Hospital, 1248-1 Otoda-cho, Ikoma, Nara, 630-0293, Japan
| | - Soichiro Hanada
- Department of Respiratory Medicine and Allergology, Kindai University Nara Hospital, 1248-1 Otoda-cho, Ikoma, Nara, 630-0293, Japan
| | - Hirochiyo Sawaguchi
- Department of Respiratory Medicine and Allergology, Kindai University Nara Hospital, 1248-1 Otoda-cho, Ikoma, Nara, 630-0293, Japan
| | - Yuji Tohda
- Department of Respiratory Medicine and Allergology, Kindai University Hospital, 377-2 Ohnohigashi, Osakasayama, Osaka, 589-8511, Japan
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Xing G, Woo AYH, Pan L, Lin B, Cheng MS. Recent Advances in β 2-Agonists for Treatment of Chronic Respiratory Diseases and Heart Failure. J Med Chem 2020; 63:15218-15242. [PMID: 33213146 DOI: 10.1021/acs.jmedchem.0c01195] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
β2-Adrenoceptor (β2-AR) agonists are widely used as bronchodilators. The emerge of ultralong acting β2-agonists is an important breakthrough in pulmonary medicine. In this review, we will provide mechanistic insights into the application of β2-agonists in asthma, chronic obstructive pulmonary disease (COPD), and heart failure (HF). Recent studies in β-AR signal transduction have revealed opposing functions of the β1-AR and the β2-AR on cardiomyocyte survival. Thus, β2-agonists and β-blockers in combination may represent a novel strategy for HF management. Allosteric modulation and biased agonism at the β2-AR also provide a theoretical basis for developing drugs with novel mechanisms of action and pharmacological profiles. Overlap of COPD and HF presents a substantial clinical challenge but also a unique opportunity for evaluation of the cardiovascular safety of β2-agonists. Further basic and clinical research along these lines can help us develop better drugs and innovative strategies for the management of these difficult-to-treat diseases.
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Affiliation(s)
- Gang Xing
- Department of Medicinal Chemistry, School of Pharmaceutical Engineering, Shenyang Pharmaceutical University, Shenyang 110016, China.,Key Laboratory of Structure-Based Drug Design and Discovery of Ministry of Education, Shenyang Pharmaceutical University, Shenyang 110016, China
| | - Anthony Yiu-Ho Woo
- Department of Pharmacology, School of Life Sciences and Biopharmaceutics, Shenyang Pharmaceutical University, Shenyang 110016, China
| | - Li Pan
- Department of Medicinal Chemistry, School of Pharmaceutical Engineering, Shenyang Pharmaceutical University, Shenyang 110016, China.,Key Laboratory of Structure-Based Drug Design and Discovery of Ministry of Education, Shenyang Pharmaceutical University, Shenyang 110016, China
| | - Bin Lin
- Department of Medicinal Chemistry, School of Pharmaceutical Engineering, Shenyang Pharmaceutical University, Shenyang 110016, China.,Key Laboratory of Structure-Based Drug Design and Discovery of Ministry of Education, Shenyang Pharmaceutical University, Shenyang 110016, China
| | - Mao-Sheng Cheng
- Department of Medicinal Chemistry, School of Pharmaceutical Engineering, Shenyang Pharmaceutical University, Shenyang 110016, China.,Key Laboratory of Structure-Based Drug Design and Discovery of Ministry of Education, Shenyang Pharmaceutical University, Shenyang 110016, China
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Tinè M, Bazzan E, Semenzato U, Biondini D, Cocconcelli E, Balestro E, Casara A, Baraldo S, Turato G, Cosio MG, Saetta M. Heart Failure is Highly Prevalent and Difficult to Diagnose in Severe Exacerbations of COPD Presenting to the Emergency Department. J Clin Med 2020; 9:E2644. [PMID: 32823938 PMCID: PMC7466112 DOI: 10.3390/jcm9082644] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 08/11/2020] [Accepted: 08/12/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Some 20% of patients with stable Chronic Obstructive Pulmonary Disease (COPD) might have heart failure (HF). HF contribution to acute exacerbations of COPD (AECOPD) presenting to the emergency department (ED) is not well established. AIMS To assess (1) the HF incidence in patients presenting to the ED with AECOPD; (2) the concordance between ED and respiratory ward (RW) diagnosis; (3) the factors associated with risk of death after hospital discharge. METHODS Retrospective chart review of 119 COPD patients presenting to ED for acute exacerbation of respiratory symptoms and then admitted to RW where a final diagnosis of AECOPD, AECOPD and HF and AECOPD and OD (other diagnosis), was obtained. ED and RW diagnosis were then compared. Factors affecting survival at follow-up were investigated. RESULTS At RW, 40.3% of cases were diagnosed of AECOPD, 40.3% of AECOPD and HF and 19.4% of AECOPD and OD, with ED diagnosis coinciding with RW's in 67%, 23%, and 57% of cases respectively. At RW, 60% of patients in GOLD1 had HF, of which 43% were diagnosed at ED, while 40% in GOLD4 had HF that was never diagnosed at ED. Lack of inclusion in a COPD care program, HF, and early readmission for AECOPD were associated with mortality. CONCLUSIONS HF is highly prevalent and difficult to diagnose in patients in all GOLD stages presenting to the ED with severe AECOPD, and along with lack of inclusion in a COPD care program, confers a high risk for mortality.
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Affiliation(s)
- Mariaenrica Tinè
- Department of Cardio-Thoracic-Vascular Sciences and Public Health, University of Padova, 35127 Padova, Italy; (M.T.); (E.B.); (U.S.); (D.B.); (E.C.); (E.B.); (A.C.); (S.B.); (G.T.); (M.G.C.)
| | - Erica Bazzan
- Department of Cardio-Thoracic-Vascular Sciences and Public Health, University of Padova, 35127 Padova, Italy; (M.T.); (E.B.); (U.S.); (D.B.); (E.C.); (E.B.); (A.C.); (S.B.); (G.T.); (M.G.C.)
| | - Umberto Semenzato
- Department of Cardio-Thoracic-Vascular Sciences and Public Health, University of Padova, 35127 Padova, Italy; (M.T.); (E.B.); (U.S.); (D.B.); (E.C.); (E.B.); (A.C.); (S.B.); (G.T.); (M.G.C.)
| | - Davide Biondini
- Department of Cardio-Thoracic-Vascular Sciences and Public Health, University of Padova, 35127 Padova, Italy; (M.T.); (E.B.); (U.S.); (D.B.); (E.C.); (E.B.); (A.C.); (S.B.); (G.T.); (M.G.C.)
| | - Elisabetta Cocconcelli
- Department of Cardio-Thoracic-Vascular Sciences and Public Health, University of Padova, 35127 Padova, Italy; (M.T.); (E.B.); (U.S.); (D.B.); (E.C.); (E.B.); (A.C.); (S.B.); (G.T.); (M.G.C.)
| | - Elisabetta Balestro
- Department of Cardio-Thoracic-Vascular Sciences and Public Health, University of Padova, 35127 Padova, Italy; (M.T.); (E.B.); (U.S.); (D.B.); (E.C.); (E.B.); (A.C.); (S.B.); (G.T.); (M.G.C.)
| | - Alvise Casara
- Department of Cardio-Thoracic-Vascular Sciences and Public Health, University of Padova, 35127 Padova, Italy; (M.T.); (E.B.); (U.S.); (D.B.); (E.C.); (E.B.); (A.C.); (S.B.); (G.T.); (M.G.C.)
| | - Simonetta Baraldo
- Department of Cardio-Thoracic-Vascular Sciences and Public Health, University of Padova, 35127 Padova, Italy; (M.T.); (E.B.); (U.S.); (D.B.); (E.C.); (E.B.); (A.C.); (S.B.); (G.T.); (M.G.C.)
| | - Graziella Turato
- Department of Cardio-Thoracic-Vascular Sciences and Public Health, University of Padova, 35127 Padova, Italy; (M.T.); (E.B.); (U.S.); (D.B.); (E.C.); (E.B.); (A.C.); (S.B.); (G.T.); (M.G.C.)
| | - Manuel G. Cosio
- Department of Cardio-Thoracic-Vascular Sciences and Public Health, University of Padova, 35127 Padova, Italy; (M.T.); (E.B.); (U.S.); (D.B.); (E.C.); (E.B.); (A.C.); (S.B.); (G.T.); (M.G.C.)
- Meakins-Christie Laboratories, Respiratory Division, McGill University, Montreal, QC H4A3J1, Canada
| | - Marina Saetta
- Department of Cardio-Thoracic-Vascular Sciences and Public Health, University of Padova, 35127 Padova, Italy; (M.T.); (E.B.); (U.S.); (D.B.); (E.C.); (E.B.); (A.C.); (S.B.); (G.T.); (M.G.C.)
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