Therapeutic efficacy of oral pirbuterol in severe chronic congestive heart failure: Acute hemodynamic and long-term ambulatory evaluation

Awan, Najam A.; Needham, Kathleen E.; Evenson, Mark K.; Hermanovich, John; Joye, James A.; DeMaria, Anthony N.; Mason, Dean T.

doi:10.1016/0002-8703(81)90744-4

Cited by 25 publications

(4 citation statements)

References 15 publications

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“…On one hand, they are consistent with smaller studies showing activation of up‐regulated β2‐adrenoceptors by exogenous B2As, causing direct myocardial injury, increasing risk of cardiomyopathy, and HF 10–12. However, on the other hand, B2As have demonstrated initially beneficial effects on pulmonary function and cardiovascular haemodynamics in some studies 13–17…”

Section: Introductionsupporting

confidence: 82%

Are beta2‐agonists responsible for increased mortality in heart failure?

Bermingham

O'Callaghan

Dawkins

et al. 2011

European J of Heart Fail

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AimsPrevious large-scale, retrospective studies have shown increased mortality in heart failure (HF) patients using b2-agonists (B2As). We further examined the relationship between B2A use and mortality in a well-characterized population by adjusting for natriuretic peptide levels as a measure of HF severity. Methods and resultsThis was a retrospective cohort study of patients attending an HF Disease Management Programme with mean follow-up of 2.9 + 2.4 years. Chart review confirmed B2A use, dose and duration of use, and documented pulmonary function evaluation. The primary endpoint was the effect of B2A use compared with no B2A use on mortality using unadjusted and adjusted Kaplan2Meier survival curves. Data were available for 1294 patients (age 70.6 + 11.5 years) of whom 64% were male and 22.2% were taking B2As. b2-Agonist users were older, more likely to be male, to have smoked, to have chronic obstructive pulmonary disease (COPD) and asthma, and less likely to take beta-blockers. Multivariable associates of mortality included: B-type natriuretic peptide (BNP), coronary artery disease, age, and beta-blocker use. Unadjusted mortality rates for B2A users were found to be significantly higher than non-B2A users [hazard ratio (HR) 1.304, 95% confidence interval (CI) 1.030-1.652, P ¼ 0.028]. However, when adjusted for age, sex, medication, co-morbidity, smoking, COPD, and BNP differences, overall mortality rates were similar [HR 1.043, 95% CI (0.771 -1.412), P ¼ 0.783]. ConclusionUnlike previous reports, this retrospective evaluation of B2A therapy in HF patients shows no relationship with longterm mortality when adjusted for population differences including BNP. Large, prospective studies are required to define the risk/benefit ratio of B2As in patients with heart failure.--

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Section: Introductionsupporting

confidence: 82%

Are beta2‐agonists responsible for increased mortality in heart failure?

Bermingham

O'Callaghan

Dawkins

et al. 2011

European J of Heart Fail

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“…Of the three studies examining inhaled agents, one showed no change in blood pressure and two showed a slight decrease in diastolic blood pressure (4 -7 mm Hg), with no change in mean or systolic blood pressure (8 -10). Five studies demonstrated slight decreases in mean blood pressure (7-10 mm Hg) after administration of oral pirbuterol and one showed a decrease of 22 mm Hg in mean blood pressure after the administration of oral terbutaline (13)(14)(15)(16)26,31). The acute improvement in cardiovascular hemodynamics induced by beta-2 agonists provides a theoretical benefit to patients with dyspnea due to heart failure.…”

Section: Effect Of Acutely Delivered Beta-2 Agonists On Cardiovasculamentioning

confidence: 99%

“…However, there is no evidence in the studies reviewed to suggest that acute beta-2 agonist administration increases or worsens myocardial ischemia, either from direct evidence in patients with ADHF or from indirect evidence in patients with chronic heart failure, and no electrocardiographic changes suggestive of ischemia were observed (8,9,15,18,20,22,23,25,26,28). In fact, Dawson et al showed that when albuterol was administered to 31 patients with myocardial infarction and cardiogenic shock, hemodynamics improved and no subject developed worsening ischemia (20).…”

Section: Effects Of Beta-2 Agonists In Heart Failure Patients With Acmentioning

confidence: 99%

Should Acute Treatment with Inhaled Beta Agonists be Withheld from Patients with Dyspnea Who May Have Heart Failure?

Maak¹,

Tabas²,

McClintock³

2011

The Journal of Emergency Medicine

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“…26 Both these groups also attempted to answer the question of whether the acute haemodynamic benefits of pirbuterol are maintained during long term treatment. Colucci et al25 studied only 12 patients compared with our larger number.…”

Section: Exercise Testsmentioning

confidence: 99%

Symptoms, haemodynamics, and exercise capacity during long term treatment of chronic heart failure. Experience with pirbuterol.

Dawson¹,

Canepa‐Anson²,

Kuan³

et al. 1983

Heart

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suMMARY An open study of long term treatment with an oral beta2 agonist (pirbuterol 20 mg three times daily) was undertaken in 63 patients with severe chronic heart failure. During three months of treatment 20 (32%) patients died, of whom 16 were taking the drug at the time of death. Mortality was related to initial functional class (New York Heart Association classification: 23% in grade III and 75% in grade IV). Concomitant treatment with digoxin did not affect mortality. The drug was well tolerated by most patients but unwanted side effects necessitated withdrawal of the drug in six (10%). Thirty-five patients were continuing to take the drug after three months, of whom 22 reported symptomatic improvement and only four deterioration. There was a relation between symptomatic improvement and increase in exercise capacity. At initial haemodynamic assessment a single dose of pirbuterol increased the cardiac index by 34% and the stroke index by 21%. Left ventricular filling pressure fell by 23% and systemic vascular resistance by 22%. Haemodynamic reassessment after three months of continuous treatment in 29 patients showed maintained improvement in the group as a whole, although individual variation was considerable. There was no apparent relation between haemodynamic improvement and improvement in exercise duration and symptoms.Severe heart failure has a poor prognosis. Identification of those patients who may derive benefit from treatment with a particular drug is not yet possible.Severe chronic heart failure refractory to conventional treatment with diuretics and digitalis remains a major therapeutic problem. That vasodilator drugs in this group of patients produce acute haemodynamic benefit is well established'-9 but the clinical benefits of long term treatment with many of these agents are less certain and the natural history of the condition has not been shown to be altered. Some reports show sustained clinical and haemodynamic benefit2 4-69-11 but others do not, and haemodynamic tolerance develops in a proportion of patients treated with hydralazine,3 prazosin,2 13 and isosorbide dinitrate.'4 One uniform characteristic of these disparate reports is the small number of patients that comprise the study groups.In this paper we report the results of an open study Accepted for publication 7 June 1983 in a large series of 63 patients with severe chronic heart failure treated long term with pirbuterol, a drug currently marketed in Britain for the treatment of asthma. Pirbuterol is a beta2 adrenergic agonist with both vasodilator and positive inotropic properties. 15 Patients and methods Sixty-three patients (55 men and eight women) entered the study. Their ages ranged from 37-73 years (mean 60 years). The aetiology of heart failure was coronary artery disease in 50 patients, dilated cardiomyopathy in 11, and poor left ventricular function after aortic valve replacement in two. Fifty six of the patients were in sinus rhythm and seven were in atrial fibrillation.Most patients were severely rather than moderately...

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Therapeutic efficacy of oral pirbuterol in severe chronic congestive heart failure: Acute hemodynamic and long-term ambulatory evaluation

Cited by 25 publications

References 15 publications

Are beta2‐agonists responsible for increased mortality in heart failure?

Are beta2‐agonists responsible for increased mortality in heart failure?

Should Acute Treatment with Inhaled Beta Agonists be Withheld from Patients with Dyspnea Who May Have Heart Failure?

Symptoms, haemodynamics, and exercise capacity during long term treatment of chronic heart failure. Experience with pirbuterol.

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