Abstract

Background: bronchodilators are the major class of drugs prescribed for chronic obstructive pulmonary disease (COPD). Meanwhile, treatment strategies for obstructive lung disease using bronchodilators are continually discussed and reviewed, in particular, with regard to their potential effect on cardiovascular system. Aim: to evaluate the effect of the combination of a short-acting β2-agonist plus an anticholinergic medication (fenoterol 50 μg/dose + ipratropium bromide 20 μg/dose, 2 doses) on the efficacy of coronary blood flow in COPD patients. Patients and Methods: spirometry with bronchodilator testing (at least 12 hours after using the medication) was performed in 30 COPD patients. The efficacy of coronary blood flow was assessed by central subendocardial viability ratio (C_SEVR) measured by applanation tonometry which was performed before and 15, 30, and 60 min after using the bronchodilator. Oxygen saturation was measured at all stages of the study. Results: the combination of fenoterol and ipratropium bromide resulted in the increase of C_SEVR by 9.5 [3.3; 10.8]% in patients with low oxygen saturation at baseline due to heart rate reduction, diastolic lengthening, and oxygen level improvement. The timing of the effect was determined by the reversibility of bronchial obstruction. No effects of the combination of fenoterol and ipratropium bromide on central and peripheral blood pressure were reported. Conclusion: low oxygen saturation at baseline and reversible bronchial obstruction in COPD patients allow for a favorable predicted systemic effect of the combination of fenoterol and ipratropium bromide. When using in therapeutic dosages and according to recommended dosage regimen, this combination improves bronchopulmonary function, oxygen saturation, and the efficacy of coronary blood flow measured by applanation tonometry. KEYWORDS: chronic obstructive pulmonary disease, applanation tonometry, central subendocardial viability ratio, SEVR, bronchial obstruction, oxygen saturation. FOR CITATION: Punin D.A. Effect of the combination of a short-acting β2-agonist plus an anticholinergic drug on the efficacy of coronary blood flow measured by applanation tonometry in chronic obstructive pulmonary disease. Russian Medical Inquiry. 2020;4(4):199–206. DOI: 10.32364/2587-6821-2020-4-4-199-206.

Highlights

  • Due to the exponential increase in medical research publications, practical syntheses are needed to guide policy makers and health care professionals in delivering evidence-based care

  • In studies involving children and young adults, these analyses showed that fractional concentration of exhaled nitric oxide (FENO)-guided treatment was associated with significantly fewer exacerbations and lower exacerbation rate than treatment based on current guidelines

  • Asthma is a heterogeneous disease, usually characterized by chronic airway inflammation. It is defined by the history of respiratory symptoms such as wheeze, shortness of breath, chest tightness and cough that vary over time and in intensity, together with variable expiratory airflow limitation

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Summary

KEY POINTS

Asthma is a heterogeneous disease, usually characterized by chronic airway inflammation. It is defined by the history of respiratory symptoms such as wheeze, shortness of breath, chest tightness and cough that vary over time and in intensity, together with variable expiratory airflow limitation. Making the diagnosis of asthma,[9] as shown in Box 1-1 (p16) is based on identifying both a characteristic pattern of respiratory symptoms such as wheezing, shortness of breath (dyspnea), chest tightness or cough, and variable expiratory airflow limitation. Diagnostic criteria for asthma in adults, adolescents, and children 6–11 years

Confirmed variable expiratory airflow limitation
ASSESS
ADJUST
REVIEW RESPONSE
Chapter 2.
Assess comorbidities
Risk factors for poor asthma outcomes
PART A. GENERAL PRINCIPLES OF ASTHMA MANAGEMENT
Treating to control symptoms and minimize future risk
Patient characteristics or phenotype
PART B. MEDICATIONS AND STRATEGIES FOR SYMPTOM CONTROL AND RISK REDUCTION
PART C. GUIDED ASTHMA SELF-MANAGEMENT EDUCATION AND SKILLS TRAINING
PART D. MANAGING ASTHMA WITH COMORBIDITIES AND IN SPECIAL POPULATIONS
Management of worsening asthma and exacerbations
Objective measurements
Objective assessments
Chapter 5.
OBJECTIVE
BACKGROUND
PART A. DIAGNOSIS
Diagnosis and management of asthma in children 5 years and younger
PART B. ASSESSMENT AND MANAGEMENT
Future risk for poor asthma outcomes
Chapter 7.
Primary prevention of asthma
SECTION 3. TRANSLATION INTO CLINICAL
INTRODUCTION
Develop a step-by-step implementation plan:
EVALUATION OF THE IMPLEMENTATION PROCESS
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