Safety and tolerability of inhalational anticholinergics in COPD

Sharafkhaneh, Amir; Majid, Hafsa; Gross, Nicholas J.

doi:10.2147/dhps.s7771

Cited by 23 publications

(18 citation statements)

References 39 publications

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“…Typical adverse effects, such as dry mouth, blurred vision, throat irritation, rhinitis, constipation and nausea, are due to blocking of muscarinic receptors. Other possible adverse effects include also arrhythmias, urinary retention/obstruction, elevated intraocular pressure and acute or worsening of narrow-angle glaucoma 79 .…”

Section: Pharmacotherapy Of Stable Copdmentioning

confidence: 99%

See 1 more Smart Citation

Diagnosis and Pharmacotherapy of Stable Chronic Obstructive Pulmonary Disease: The Finnish Guidelines

Kankaanranta

Harju

Kilpeläinen

et al. 2015

Basic Clin Pharma Tox

104

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The Finnish Medical Society Duodecim initiated and managed the update of the Finnish national guideline for chronic obstructive pulmonary disease (COPD). The Finnish COPD guideline was revised to acknowledge the progress in diagnosis and management of COPD. This Finnish COPD guideline in English language is a part of the original guideline and focuses on the diagnosis, assessment and pharmacotherapy of stable COPD. It is intended to be used mainly in primary health care but not forgetting respiratory specialists and other healthcare workers. The new recommendations and statements are based on the best evidence available from the medical literature, other published national guidelines and the GOLD (Global Initiative for Chronic Obstructive Lung Disease) report. This guideline introduces the diagnostic approach, differential diagnostics towards asthma, assessment and treatment strategy to control symptoms and to prevent exacerbations. The pharmacotherapy is based on the symptoms and a clinical phenotype of the individual patient. The guideline defines three clinically relevant phenotypes including the low and high exacerbation risk phenotypes and the neglected asthma–COPD overlap syndrome (ACOS). These clinical phenotypes can help clinicians to identify patients that respond to specific pharmacological interventions. For the low exacerbation risk phenotype, pharmacotherapy with short-acting β2-agonists (salbutamol, terbutaline) or anticholinergics (ipratropium) or their combination (fenoterol–ipratropium) is recommended in patients with less symptoms. If short-acting bronchodilators are not enough to control symptoms, a long-acting β2-agonist (formoterol, indacaterol, olodaterol or salmeterol) or a long-acting anticholinergic (muscarinic receptor antagonists; aclidinium, glycopyrronium, tiotropium, umeclidinium) or their combination is recommended. For the high exacerbation risk phenotype, pharmacotherapy with a long-acting anticholinergic or a fixed combination of an inhaled glucocorticoid and a long-acting β2-agonist (budesonide–formoterol, beclomethasone dipropionate–formoterol, fluticasone propionate–salmeterol or fluticasone furoate–vilanterol) is recommended as a first choice. Other treatment options for this phenotype include combination of long-acting bronchodilators given from separate inhalers or as a fixed combination (glycopyrronium–indacaterol or umeclidinium–vilanterol) or a triple combination of an inhaled glucocorticoid, a long-acting β2-agonist and a long-acting anticholinergic. If the patient has severe-to-very severe COPD (FEV1 < 50% predicted), chronic bronchitis and frequent exacerbations despite long-acting bronchodilators, the pharmacotherapy may include also roflumilast. ACOS is a phenotype of COPD in which there are features that comply with both asthma and COPD. Patients belonging to this phenotype have usually been excluded from studies evaluating the effects of drugs both in asthma and in COPD. Thus, evidence-based recommendation of treatment cannot be given. The treatment should cover b...

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Section: Pharmacotherapy Of Stable Copdmentioning

confidence: 99%

“…The short-acting anticholinergic ipratropium has been suspected to induce cardiac adverse effects 79 . With the long-acting anticholinergics, no similar increase in cardiac adverse effects has been reported with certainty 79 .…”

Section: Pharmacotherapy Of Stable Copdmentioning

confidence: 99%

Diagnosis and Pharmacotherapy of Stable Chronic Obstructive Pulmonary Disease: The Finnish Guidelines

Kankaanranta

Harju

Kilpeläinen

et al. 2015

Basic Clin Pharma Tox

104

View full text Add to dashboard Cite

show abstract

“…Similarly, cardiovascular safety was specifically assessed for LAMAs, which are known to be associated with cardiovascular adverse events, such as arrhythmias [77]. Tiotropium did not increase the risk of cardiac events, mortality and serious adverse events even in patients who experienced recent myocardial infarction, heart failure, and unstable rhythm disorders [78].…”

Section: Management Of Cardiovascular Disease Concomitant With Copdmentioning

confidence: 99%

Multidimensional approach for the proper management of a complex chronic patient with chronic obstructive pulmonary disease

Rogliani

Brusasco

Fabbri

et al. 2017

Expert Review of Respiratory Medicine

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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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“…Az esetleges mellékhatást több tényező befolyásol-hatja [60]: -farmakokinetika (l. előbb), -belégzőeszköz, -betegtényezők.…”

Section: Következtetésekunclassified

Van-e cardiovascularis mellékhatásuk az inhalációs antikolinerg szereknek?

Nagy¹

2015

Orvosi Hetilap

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Az összefoglaló célja az inhalációs antikolinerg szerek cardiovascularis veszélyének tárgyalása krónikus obstruktív tü-dőbetegségben. A tiotropium-használat adatainak néhány metaanalízise felvetette ilyen mellékhatások (arrhythmia, angina, szívinfarktus stb.) fokozott lehetőségét. Az összefoglaló áttekinti a retrospektív adatbázis-feldolgozásokat, a randomizált kontrollcsoportos vizsgálatokat és a klinikai vizsgálatok metaanalíziseit. Az adatbázis-vizsgálatok eredményei inkonzisztensek. A legtöbb klinikai vizsgálatban a cardiovascularis mellékhatások incidenciája azonos volt az aktív kezelésű és a placebocsoportban, jellemzően azoknál a betegeknél is, akik előzőleg cardiovascularis betegségben szenvedtek. A metaanalízisekben kevés a bizonyíték vagy egyáltalán nincs arra nézve, hogy összefüggés van az antikolinergek és a cardiovascularis tünetek között. A szerző áttekinti a humán szív kolinergreceptor-altípusait és funkcióját, a szívműködés ezen receptorok útján történő autonóm szabályozását, ezek lehetséges szerepét és az inhalált antikolinerg szerek farmakokinetikai tulajdonságait. Megállapítja, hogy nincs bizonyíték az inhalációs antikolinerg szerek fokozott cardiovascularis ártalmára. Orv. Hetil., 2015, 156(31), 1246-1252. Kulcsszavak: krónikus obstruktív tüdőbetegség, inhalációs antikolinerg szerek, cardiovascularis szövődmények Are there cardiovascular adverse effects of inhaled anticholinergics?The purpose of this review is to discuss the cardiovascular risk associated with inhaled anticholinergics in chronic obstructive pulmonary disease. Several meta-analyses of data for tiotropium raised the possibility of an increased risk for arrhythmia, angina, myocardial infarction, etc. This review includes the data of retrospective studies of databases using databases, randomized controlled trials, and meta-analyses of clinical trials. The conclusions of studies were inconsistent. In most clinical trials the incidence of cardiovascular adverse events was similar in active treatment and placebo groups, especially in patients with previous cardiovascular diseases. Considering meta-analyses, there is little, if any, evidence for the association between anticholinergics and the development of cardiovascular symptoms. The author discusses the presence and function of cholinergic receptor subtypes in human heart, and cardiac functions controlled by the autonomic nervous system via these receptors, their possible role, and pharmacokinetic properties of inhaled anticholinergics. The author concludes that it is not possible to fi nd evidence of increased cardiovascular harm of inhaled anticholinergics.Keywords: chronic obstructive pulmonary disease, inhaled anticholinergics, adverse cardiovascular events Nagy, L. B. [Are there cardiovascular adverse effects of inhaled anticholinergics?]. Orv. Hetil., 2015, 156(31), 1246-1252. (Beérkezett: 2015 elfogadva: 2015. május 18.) Rövidítések cAMP = ciklikus adenozin-monofoszfát; COPD = krónikus obstruktív tüdőbetegség; FEV1 = forszírozott másodpercvolu-men; ISZB = ischaemiás s...

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Safety and tolerability of inhalational anticholinergics in COPD

Cited by 23 publications

References 39 publications

Diagnosis and Pharmacotherapy of Stable Chronic Obstructive Pulmonary Disease: The Finnish Guidelines

Diagnosis and Pharmacotherapy of Stable Chronic Obstructive Pulmonary Disease: The Finnish Guidelines

Multidimensional approach for the proper management of a complex chronic patient with chronic obstructive pulmonary disease

Van-e cardiovascularis mellékhatásuk az inhalációs antikolinerg szereknek?

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