英文bblockerinpatientswithcoexistentHFandreactiveairway課件

1、英文bblockerinpatientswithcoexistentHFandreactiveairwayb b-blocker in patients with coexistent HF and reactive airway disease英文bblockerinpatientswithcoexistentHFandreactiveairwayBackground Beta blockers are recommended for the treatment of all patients (in NYHA class II-IV) with stable, mild, moderate

2、, and severe HF from ischaemic or non-ischaemic cardiomyopathies and reduced LVEF on standard treatment, including diuretics and ACEI, unless there is a contraindication. (evidence class IA) Beta blockers therapy reduce hospitalizations (all, CV and HF), improves the functional class and leads to le

3、ss worsening of HF. (Reduction all-cause mortality) (evidence class IA)ESC guideline for CHF; 2005.英文bblockerinpatientswithcoexistentHFandreactiveairway The patient should be in a relatively stable condition, without the need of intravenous inotropic therapy and without signs of marked fluid retenti

4、on. Differences in clinical effects may be present between different beta-blockers in patients with HF. Only bisoprolol, carvedilol, metoprolol succinate, and nebivolol can be recommended. (evidence class IA)ESC guideline for CHF; 2005.Background英文bblockerinpatientswithcoexistentHFandreactiveairwayC

5、ontraindications to beta-blockers Asthma bronchiale Severe bronchial disease (ex: COPD) Symptomatic bradycardia or hypotensionBackgroundESC guideline for CHF; 2005.英文bblockerinpatientswithcoexistentHFandreactiveairwayP.I.C.O.Patients(P)Intervention (I)Comparison(C)Outcome(O)HF with airway diseasebet

6、a-blockersPlaceboFEV1 changePt symptomMortality英文bblockerinpatientswithcoexistentHFandreactiveairway英文bblockerinpatientswithcoexistentHFandreactiveairway英文bblockerinpatientswithcoexistentHFandreactiveairwayDatabase SearchCochrane Library key word: heart failure and airway disease and beta-blocker Fo

7、und: 2/9 related results * Cardioselective beta-blockers for chronic obstructive pulmonary disease. * Cardioselective beta-blockers for reversible airway disease.英文bblockerinpatientswithcoexistentHFandreactiveairway英文bblockerinpatientswithcoexistentHFandreactiveairway英文bblockerinpatientswithcoexiste

8、ntHFandreactiveairwayDatabase SearchBandolier key word: heart failure, airway disease, COPD, beta-blocker Found: No related result 英文bblockerinpatientswithcoexistentHFandreactiveairwayDatabase SearchACP Journal Club key word: heart failure, airway disease, COPD, beta-blocker Found: No related result

9、 英文bblockerinpatientswithcoexistentHFandreactiveairway英文bblockerinpatientswithcoexistentHFandreactiveairwayDatabase SearchEMBASE- Drugs & Pharmacology key word: heart failure, airway disease, beta-blockers Found: 2/42 related results 英文bblockerinpatientswithcoexistentHFandreactiveairway英文bblocke

10、rinpatientswithcoexistentHFandreactiveairway英文bblockerinpatientswithcoexistentHFandreactiveairwayDatabase SearchPub-Med Clinical Queries-systematic review key word: heart failure, airway disease Found: 3/26 related results英文bblockerinpatientswithcoexistentHFandreactiveairway英文bblockerinpatientswithc

11、oexistentHFandreactiveairway英文bblockerinpatientswithcoexistentHFandreactiveairway英文bblockerinpatientswithcoexistentHFandreactiveairwayDatabase SearchPub-Med key word: heart failure, airway disease,Carvedilol Found: 2 related results英文bblockerinpatientswithcoexistentHFandreactiveairwayEMBASE英文bblocke

12、rinpatientswithcoexistentHFandreactiveairwayResults. Cardioselective b b-blockers for reversible airway disease or COPD Non-selective a a, b b-blockerCarvedilol, use in pts with HF and COPD or Asthma Conclusion英文bblockerinpatientswithcoexistentHFandreactiveairwayCardioselective beta-blockers for rev

13、ersible airway disease S Salpeter, T Ormiston, E Salpeter, R Wood-BakerThe Cochrane Database of Systematic Reviews 2005 Issue 4Copyright 2005 The Cochrane Collaboration. Published by John Wiley & Sons, DOI: 10.1002/14651858.CD002992 This version first published online: 21 October 2002 in Issue 4

14、, 2002英文bblockerinpatientswithcoexistentHFandreactiveairwayObjectives To assess the effect of cardioselective beta-blockers in patients with asthma or chronic obstructive pulmonary disease (COPD).Selection criteria Randomized, blinded, placebo-controlled trials of single dose or continued treatment

15、of the effects of cardioselective beta-blockers in patients with reversible airway disease.Data collection and analysis We divided beta1-blockers into those with or without intrinsic sympathomimetic activity (ISA). Interventions were: administration of single dose or continued beta1-blocker(3-28 day

16、s), and response to beta2-agonist given after the study drug.Main results 19 studies on single-dose treatment and 10 studies on continued treatment met the inclusion criteria.英文bblockerinpatientswithcoexistentHFandreactiveairwayResultbeta-blocker v.s placebo: Single doseThe Cochrane Database of Syst

17、ematic Reviews 2005 Issue 4 英文bblockerinpatientswithcoexistentHFandreactiveairwayThe Cochrane Database of Systematic Reviews 2005 Issue 4 beta-blocker v.s placebo: Single doseFEV1 treatment英文bblockerinpatientswithcoexistentHFandreactiveairwayThe Cochrane Database of Systematic Reviews 2005 Issue 4 b

18、eta-blocker v.s placebo: Single doseFEV1 treatment英文bblockerinpatientswithcoexistentHFandreactiveairwayBeta-blocker categoriesThe Cochrane Database of Systematic Reviews 2005 Issue 4 Carvedilol (+ alpha block)Carteolol (Mikelan)*英文bblockerinpatientswithcoexistentHFandreactiveairwayThe Cochrane Datab

19、ase of Systematic Reviews 2005 Issue 4 beta-blocker v.s placebo: Single dosesubgroup: COPD-FEV1英文bblockerinpatientswithcoexistentHFandreactiveairwayThe Cochrane Database of Systematic Reviews 2005 Issue 4 beta-blocker v.s placebo: Single dosesubgroup: CVD-FEV1英文bblockerinpatientswithcoexistentHFandr

20、eactiveairwayThe Cochrane Database of Systematic Reviews 2005 Issue 4 Resultbeta-blocker+agonist v.s placebo+agonist: Single dose英文bblockerinpatientswithcoexistentHFandreactiveairwayThe Cochrane Database of Systematic Reviews 2005 Issue 4 beta-blocker+agonist v.s placebo+agonist: Single doseFEV1 tre

21、atment英文bblockerinpatientswithcoexistentHFandreactiveairwayThe Cochrane Database of Systematic Reviews 2005 Issue 4 beta-blocker+agonist v.s placebo+agonist: Single doseFEV1 treatment英文bblockerinpatientswithcoexistentHFandreactiveairwayThe Cochrane Database of Systematic Reviews 2005 Issue 4 Resultb

22、eta-blocker v.s placebo: Longer duration英文bblockerinpatientswithcoexistentHFandreactiveairwayThe Cochrane Database of Systematic Reviews 2005 Issue 4 Resultbeta-blocker+agonist v.s placebo+agonist: Longer duration英文bblockerinpatientswithcoexistentHFandreactiveairwayThe Cochrane Database of Systemati

23、c Reviews 2005 Issue 4 beta-blocker+agonist v.s placebo+agonist: Longer durationFEV1 treatment英文bblockerinpatientswithcoexistentHFandreactiveairwayBeta-blockers reduce mortality in patients with hypertension, heart failure and coronary arterial disease. Traditionally they have not been given to pati

24、ents with reversible airway disease (asthma or COPD with a reversible obstructive component). This review of randomized controlled trials, that evaluated cardioselective beta-blocker given in mild to moderate reversible airway disease or COPD, do not produce adverse respiratory effects in the short

25、term, these agents should not be withheld from such patients. Long term safety (especially their impact during an acute exacerbation) still needs to be established.ConclusionThe Cochrane Database of Systematic Reviews 2005 Issue 4 英文bblockerinpatientswithcoexistentHFandreactiveairwayCardioselective

26、beta-blockers for chronic obstructive pulmonary disease S Salpeter, T Ormiston, E SalpeterThe Cochrane Database of Systematic Reviews 2005 Issue 4 Copyright 2005 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.DOI: 10.1002/14651858.CD003566.pub2 This version first published onlin

27、e: 19 October 2005 in Issue 4, 2005英文bblockerinpatientswithcoexistentHFandreactiveairway Objectives To assess the effect of cardioselective beta-blockers on respiratory function of patients with COPD. Selection criteria Randomised, blinded, controlled trials of single dose or longer duration that st

28、udied the effects of cardioselective beta-blockers on the forced expiratory volume in 1 second (FEV1) or symptoms in patients with COPD. Main results 11 studies of single-dose treatment and 9 of treatment for longer durations, ranging from 2 days to 12 weeks.The Cochrane Database of Systematic Revie

29、ws 2005 Issue 4 英文bblockerinpatientswithcoexistentHFandreactiveairwayThe Cochrane Database of Systematic Reviews 2005 Issue 4 ResultsP=0.2P=1.0P=0.2P=1.0英文bblockerinpatientswithcoexistentHFandreactiveairwayThe Cochrane Database of Systematic Reviews 2005 Issue 4 P=0.8P=0.3P=0.5P=0.6P=0.5P=0.1英文bbloc

30、kerinpatientswithcoexistentHFandreactiveairwayResultsThe Cochrane Database of Systematic Reviews 2005 Issue 4 P=0.8P=0.7英文bblockerinpatientswithcoexistentHFandreactiveairwayThe available data from controlled trials suggest that cardioselective beta-blocker use in patients with COPD has no significan

31、t adverse effects on FEV1, respiratory symptoms or response to beta2-agonists, even for those with severe chronic airways obstruction. This finding was consistent whether patients had severe airways obstruction or a reversible obstructive component. Cardioselective beta-blockers should not be withhe

32、ld from patients with COPD.ConclusionThe Cochrane Database of Systematic Reviews 2005 Issue 4 英文bblockerinpatientswithcoexistentHFandreactiveairwayCarvedilol (+ alpha block)Carteolol (Mikelan)*Nebivolol英文bblockerinpatientswithcoexistentHFandreactiveairwayTolerability of Carvedilol in patients with H

33、F and concomitant COPD or asthma Kotlyar, Eugenea; Keogh, Anne M.a; Macdonald, Peter S.a; Arnold, Ruth H.a; McCaffrey, Dermot J.a; Glanville, Allan R.aJ Heart Lung Transplant 2002; 21: 1290-1295.英文bblockerinpatientswithcoexistentHFandreactiveairway Background Little information exists on the tolerab

34、ility of carvedilol in patients with chronic obstructive pulmonary disease (COPD). In this study, we assessed the tolerability and efficacy of carvedilol in patients with CHF and concomitant COPD or asthma. Methods Between 1996 and 2000, a total of 487 patients began receiving open-label carvedilol.

35、 43 (9%) had COPD (n = 31) or asthma (n = 12). 60% began carvedilol therapy in the hospital and underwent measurement of peak expiratory flow rates (PEFR) before and after dosing. Patients were observed for a mean of 2.4 years.英文bblockerinpatientswithcoexistentHFandreactiveairway17% increase (p=0.04

36、) in PEFR in patients with COPD and a non-significant increase of 4% in patients with asthma (p=0.29).J Heart Lung Transplant 2002; 21: 1290-1295.Result英文bblockerinpatientswithcoexistentHFandreactiveairwayJ Heart Lung Transplant 2002; 21: 1290-1295.1 patient (3.2%) was withdrawn from carvedilol ther

37、apy because of an exacerbation of the pulmonary disease. Four other patients (12.9%), intolerant of carvedilol, ceased therapy because of worsening heart failure.英文bblockerinpatientswithcoexistentHFandreactiveairwayJ Heart Lung Transplant 2002; 21: 1290-1295.In patients who tolerated carvedilol, ech

38、ocardiography at 12 months demonstrated a statistically improvement in LV dimensions and function accompanied by improvement in NYHA functional class in 68%.英文bblockerinpatientswithcoexistentHFandreactiveairway CONCLUSION1.Patients with CHF and COPD tolerated carvedilol well with no significant reve

39、rsible airflow limitation, but patients with CHF and asthma tolerated carvedilol poorly. 2.The effect of carvedilol on LV dimensions and function in patients with concomitant airway diseases was similar to that seen in our general group of patients.3.Asthma remains a contraindication to b-blockade.J

40、 Heart Lung Transplant 2002; 21: 1290-1295.英文bblockerinpatientswithcoexistentHFandreactiveairwaySelective beta-1-adrenergic blockade is routinely preferred to non-selective blockade in patients with coexistent COPD and CHF to minimize the risk of inducing bronchoconstriction.Recent limited evidence

41、indicates that combined non-selective beta- and alpha-adrenergic blockade is well tolerated by patients with COPD who do not have reversible airway obstruction.Alpha-1-adrenergic-blocking agents such as phentolamine and indoramine produce mild bronchodilation in patients with obstructive airway dise

42、ase and abolish propranolol-induced bronchoconstriction. Alpha -1-blocking activity of carvedilol and labetalol may be sufficient to offset beta-adrenergic blockade-induced bronchoconstriction in patients with COPD, but not in patients with asthma.JACC 2004; 44(3): 497-502.英文bblockerinpatientswithco

43、existentHFandreactiveairwaySelective beta-1-blockade or non-selective beta- combined with alpha-adrenergic blockade should not be withheld in patients with CHF and COPD without reversible airway obstruction.In patients with CHF and COPD with reversible airway obstruction, selective beta-1-blockade r

44、emains the preferred approach in the absence of safety data on agents combining non-selective beta- with alpha-adrenergic blockade. Selective beta-1-blockade and non-selective beta- combined with alpha-adrenergic blockade should be avoided during COPD exacerbation until safety data are available.JAC

45、C 2004; 44(3): 497-502.英文bblockerinpatientswithcoexistentHFandreactiveairway 總總 結(jié)結(jié)Cardioselective-nonISA beta-blocker agent (Atenolol, Bisoprolol, Metoprolol, Practolol) for reversible airway disease Total reversible airway ds pt FEV1Sub: COPDFEV1Sub: CVDFEV1Pt symptom併併beta-agonistFEV1Single dose(v.s placebo) WMD 9.14 -11.31, -6.97P 0.00001 WMD 5.28 -10.