Effects of Inhaled Tiotropium on Left Ventricular Diastolic Function in Chronic Obstructive Pulmonary Disease Patients after Pulmonary Resection

Nojiri, Takashi; Yamamoto, Keiji; Maeda, Hitoshi; Takeuchi, Yukiyasu; Funakoshi, Yasunobu; Maekura, Ryoji; Okumura, Meinoshin

doi:10.5761/atcs.oa.11.01787

Cited by 8 publications

(4 citation statements)

References 26 publications

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“…Tiotropium also reduces arterial stiffness [80]. Other potential CV benefits of LAMAs include reduction in exacerbations and an improvement in left-ventricular diastolic function, although not left-ventricular ejection fraction (LVEF) [79].…”

Section: Muscarinic Antagonistsmentioning

confidence: 99%

Cardiovascular disease and COPD: dangerous liaisons?

2018

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Chronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD) frequently occur together and their coexistence is associated with worse outcomes than either condition alone. Pathophysiological links between COPD and CVD include lung hyperinflation, systemic inflammation and COPD exacerbations. COPD treatments may produce beneficial cardiovascular (CV) effects, such as long-acting bronchodilators, which are associated with improvements in arterial stiffness, pulmonary vasoconstriction, and cardiac function. However, data are limited regarding whether these translate into benefits in CV outcomes. Some studies have suggested that treatment with long-acting β2-agonists and long-acting muscarinic antagonists leads to an increase in the risk of CV events, particularly at treatment initiation, although the safety profile of these agents with prolonged use appears reassuring. Some CV medications may have a beneficial impact on COPD outcomes, but there have been concerns about β-blocker use leading to bronchospasm in COPD, which may result in patients not receiving guideline-recommended treatment. However, there are few data suggesting harm with these agents and patients should not be denied β-blockers if required. Clearer recommendations are necessary regarding the identification and management of comorbid CVD in patients with COPD in order to facilitate early intervention and appropriate treatment.

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Section: Muscarinic Antagonistsmentioning

confidence: 99%

Cardiovascular disease and COPD: dangerous liaisons?

2018

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“…LAMA, long-acting muscarinic antagonist; LABA, long-acting β2-agonist. (14) because tiotropium improved the left ventricular diastolic function in the chronic phase after pulmonary resection (18). However, Ueda et al reported that preoperative treatment with tiotropium for ≥7 days improved lung function prior to thoracic surgery, but no effect on respiratory complications was seen (19).…”

Section: Discussionmentioning

confidence: 99%

Long‑acting muscarinic antagonist and long‑acting β2‑agonist therapy to optimize chronic obstructive pulmonary disease prior to lung cancer surgery

et al. 2018

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Bronchodilators are essential for the perioperative management of patients with chronic obstructive pulmonary disease (COPD) undergoing surgery for lung cancer. The objective of the present study was to examine whether the usage of a long-acting β2-agonist (LABA) with a long-acting muscarinic antagonist (LAMA) could optimize preoperative lung function and reduce the risk for postoperative pulmonary complications. Thirty-two consecutive patients with moderate-to-severe COPD who underwent a lobectomy for lung cancer and received preoperative LAMA (n=19) or LAMA/LABA (n=13) therapy between January 2005 and December 2015 were enrolled in this retrospective study. The improvement of preoperative pulmonary function and the postoperative morbidity were compared between the patients with preoperative LAMA, and LAMA/LABA therapy. Increases in the forced expiratory volume in one second (FEV) were significantly larger in the LAMA/LABA group than in the LAMA group (0.26±0.05 l vs. 0.07±0.05 l; P=0.0145). More patients in the LAMA/LABA group than in the LAMA group showed a marked improvement of >10% in %FEV after bronchodilators (85 vs. 32%; P=0.0046). The incidence of postoperative pneumonia was significantly lower in the LAMA/LABA group than in the LAMA group (0 vs. 26%; P=0.044). In conclusion, the present study showed that preoperative LAMA/LABA therapy was associated with larger improvements in preoperative pulmonary function and less postoperative pneumonia than LAMA therapy. These results may lead to greater improvements in FEV and less postoperative pneumonia by encouraging preoperative LAMA/LABA therapy in this patient population.

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“…Bronchodilators may prevent acute exacerbations of COPD, thus reducing the risk of cardiovascular events. Tiotropium, a LAMA, improves hyperinflation, cardiovascular responses to exercise in COPD patients [38], LV diastolic function in COPD patients [39] and it has been associated with decreased mortality (CV and no-CV) [40]. LV and right ventricular end-diastolic volume increase and LV and right ventricular stroke volume increase have been reported as effects of LABA-LAMA in COPD [41].…”

Section: Chronic Obstructive Pulmonary Diseasementioning

confidence: 99%