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Cardiovascular mortality and morbidity in chronic obstructive pulmonary disease: the impact of bronchodilator treatment

Citation

Wood-Baker, R and Cochrane, B and Naughton, MT, Cardiovascular mortality and morbidity in chronic obstructive pulmonary disease: the impact of bronchodilator treatment, Internal Medicine Journal, 40, (2) pp. 94-101. ISSN 1444-0903 (2010) [Refereed Article]


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The definitive published version is available online at: http://interscience.wiley.com

DOI: doi:10.1111/j.1445-5994.2009.02109.x

Abstract

Chronic obstructive pulmonary disease (COPD) is a substantial health burden. Cardiovascular disease (CVD), the leading cause of death, frequently coexists with COPD, an effect attributed to high individual disease prevalences and shared risk factors. It has long been recognized that COPD, whether stable or during acute exacerbations, is associated with an excess of cardiac arrhythmias. Bronchodilator medications have been implicated in the excess CVD seen in COPD, either as an intrinsic medication effect or related to side-effects. Despite the theory behind increased pro-arrhythmic effects in COPD, the reported results of trials investigating this for inhaled formulations at therapeutic doses are few. Methodological flaws, retrospective analysis and inadequate adjustment for concomitant medications, including short-acting ‘relief’ bronchodilators and non-respiratory medications with known arrhythmia propensity, mar many of these studies. For most bronchodilators at therapeutic levels in stable COPD, we can be reassured of their safety from current studies. The exception to this is ipratropium bromide, where the current data indicate an association with increased cardiovascular adverse effects. Moreover, there is no proven benefit from combining short-acting beta-agonists with short-acting anticholinergics at high doses in the acute setting, and although this practice is widespread, it is associated with increased cardiovascular risk.

Item Details

Item Type:Refereed Article
Keywords:chronic obstructive pulmonary disease, cardiovascular disease, bronchodilator agents
Research Division:Medical and Health Sciences
Research Group:Cardiorespiratory Medicine and Haematology
Research Field:Respiratory Diseases
Objective Division:Health
Objective Group:Clinical Health (Organs, Diseases and Abnormal Conditions)
Objective Field:Respiratory System and Diseases (incl. Asthma)
Author:Wood-Baker, R (Professor Richard Wood-Baker)
Author:Cochrane, B (Ms Belinda Cochrane)
ID Code:65136
Year Published:2010
Web of Science® Times Cited:14
Deposited By:Menzies Institute for Medical Research
Deposited On:2010-10-06
Last Modified:2011-05-02
Downloads:0

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