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Cardiac effects of current treatments of chronic obstructive pulmonary disease

Lies Lahousse UGent, Katia Verhamme UGent, Bruno H Stricker and Guy Brusselle UGent (2016) LANCET RESPIRATORY MEDICINE. 4(2). p.149-164
abstract
We review the cardiac safety of the drugs available at present for the maintenance treatment of chronic obstructive pulmonary disease (COPD) in stable disease, focusing on inhaled long-acting muscarinic antagonists (LAMA) and long-acting beta 2 agonists (LABA), used either as a monotherapy or as a fixed-dose combination. We report the difficulties of, and pitfalls in, the investigation of the safety of drug treatments in COPD, which is hampered by the so-called COPD trial paradox: on the one hand, COPD is defined as a systemic disease and is frequently associated with comorbidities (especially cardiovascular comorbidities), which have an important effect on the prognosis of individual patients; on the other hand, patients with COPD and cardiovascular or other coexisting illnesses are often excluded from participation in randomised controlled clinical trials. In these trials, inhaled long-acting bronchodilators, both LAMA or LABA, or both, seem to be safe when used in the appropriate dose in adherent patients with COPD without uncontrolled cardiovascular disease or other notable comorbidities. However, the cardiac safety of LAMA and LABA is less evident when used inappropriately (eg, overdosing) or in patients with COPD and substantial cardiovascular disease, prolonged QTc interval, or polypharmacy. Potential warnings about rare cardiac events caused by COPD treatment from meta-analyses and observational studies need to be confirmed in high quality large randomised controlled trials. Finally, we briefly cover the cardiac safety issues of chronic oral drug treatments for COPD, encompassing theophylline, phosphodiesterase inhibitors, and macrolides.
Please use this url to cite or link to this publication:
author
organization
year
type
journalArticle (review)
publication status
published
subject
keyword
FIXED-DOSE COMBINATIONS, QT INTERVAL PROLONGATION, POOLED SAFETY ANALYSIS, HEART-FAILURE, MYOCARDIAL-INFARCTION, BETA-ADRENOCEPTOR AGONISTS, ACLIDINIUM BROMIDE/FORMOTEROL FUMARATE, INHALED CORTICOSTEROIDS, CARDIOVASCULAR-DISEASE, COMPREHENSIVE ANALYSIS
journal title
LANCET RESPIRATORY MEDICINE
Lancet Resp. Med.
volume
4
issue
2
pages
149 - 164
Web of Science type
Review
Web of Science id
000370113400022
JCR category
RESPIRATORY SYSTEM
JCR impact factor
19.287 (2016)
JCR rank
1/59 (2016)
JCR quartile
1 (2016)
ISSN
2213-2600
DOI
10.1016/S2213-2600(15)00518-4
language
English
UGent publication?
yes
classification
A1
copyright statement
I have transferred the copyright for this publication to the publisher
id
8037292
handle
http://hdl.handle.net/1854/LU-8037292
date created
2016-07-14 16:02:34
date last changed
2016-12-19 15:42:13
@article{8037292,
  abstract     = {We review the cardiac safety of the drugs available at present for the maintenance treatment of chronic obstructive pulmonary disease (COPD) in stable disease, focusing on inhaled long-acting muscarinic antagonists (LAMA) and long-acting beta 2 agonists (LABA), used either as a monotherapy or as a fixed-dose combination. We report the difficulties of, and pitfalls in, the investigation of the safety of drug treatments in COPD, which is hampered by the so-called COPD trial paradox: on the one hand, COPD is defined as a systemic disease and is frequently associated with comorbidities (especially cardiovascular comorbidities), which have an important effect on the prognosis of individual patients; on the other hand, patients with COPD and cardiovascular or other coexisting illnesses are often excluded from participation in randomised controlled clinical trials. In these trials, inhaled long-acting bronchodilators, both LAMA or LABA, or both, seem to be safe when used in the appropriate dose in adherent patients with COPD without uncontrolled cardiovascular disease or other notable comorbidities. However, the cardiac safety of LAMA and LABA is less evident when used inappropriately (eg, overdosing) or in patients with COPD and substantial cardiovascular disease, prolonged QTc interval, or polypharmacy. Potential warnings about rare cardiac events caused by COPD treatment from meta-analyses and observational studies need to be confirmed in high quality large randomised controlled trials. Finally, we briefly cover the cardiac safety issues of chronic oral drug treatments for COPD, encompassing theophylline, phosphodiesterase inhibitors, and macrolides.},
  author       = {Lahousse, Lies and Verhamme, Katia and Stricker, Bruno H and Brusselle, Guy},
  issn         = {2213-2600},
  journal      = {LANCET RESPIRATORY MEDICINE},
  keyword      = {FIXED-DOSE COMBINATIONS,QT INTERVAL PROLONGATION,POOLED SAFETY ANALYSIS,HEART-FAILURE,MYOCARDIAL-INFARCTION,BETA-ADRENOCEPTOR AGONISTS,ACLIDINIUM BROMIDE/FORMOTEROL FUMARATE,INHALED CORTICOSTEROIDS,CARDIOVASCULAR-DISEASE,COMPREHENSIVE ANALYSIS},
  language     = {eng},
  number       = {2},
  pages        = {149--164},
  title        = {Cardiac effects of current treatments of chronic obstructive pulmonary disease},
  url          = {http://dx.doi.org/10.1016/S2213-2600(15)00518-4},
  volume       = {4},
  year         = {2016},
}

Chicago
Lahousse, Lies, Katia Verhamme, Bruno H Stricker, and Guy Brusselle. 2016. “Cardiac Effects of Current Treatments of Chronic Obstructive Pulmonary Disease.” Lancet Respiratory Medicine 4 (2): 149–164.
APA
Lahousse, L., Verhamme, K., Stricker, B. H., & Brusselle, G. (2016). Cardiac effects of current treatments of chronic obstructive pulmonary disease. LANCET RESPIRATORY MEDICINE, 4(2), 149–164.
Vancouver
1.
Lahousse L, Verhamme K, Stricker BH, Brusselle G. Cardiac effects of current treatments of chronic obstructive pulmonary disease. LANCET RESPIRATORY MEDICINE. 2016;4(2):149–64.
MLA
Lahousse, Lies, Katia Verhamme, Bruno H Stricker, et al. “Cardiac Effects of Current Treatments of Chronic Obstructive Pulmonary Disease.” LANCET RESPIRATORY MEDICINE 4.2 (2016): 149–164. Print.