Approaches to the treatment of exacerbation of chronic obstructive pulmonary disease with comorbid hypertension

Abstract

Aim. Аnalysis of the efficacy and safety of complex therapy including fixed-dose combinations of long-acting bronchodilators (FCLB) in comorbid patients with an exacerbation of chronic obstructive pulmonary disease (COPD) of the spirometry grades III – IV and hypertension.Methods. A total of 232 patients with an exacerbation of COPD of the spirometry grades III – IV were examined. 174 (75%) patients were diagnosed with the third grade (GOLD III), 58 (25%) – with the fourth spirometry grade (GOLD IV). In the GOLD III group, a moderate exacerbation was diagnosed in 22 (12.6%), severe — in 152 (87.4%). In the GOLD IV group, a moderate exacerbation was diagnosed in 5 (8.5%), severe — in 53 (91.5%), respectively. The patients were divided into 4 groups. Group 1 included 50 patients with an exacerbation of COPD of the spirometry grades III – IV without hypertension; Group 2 – 56 patients with an exacerbation of COPD and concomitant hypertension; Group 3 – 64 patients with an exacerbation of COPD without hypertension, who received FCLB in addition to standard therapy from the 3rd day of hospitalization; Group 4 – 62 patients with an exacerbation of COPD of the spirometry grades III – IV and concomitant hypertension who received FCLB in addition to standard therapy from the 3rd day of hospitalization. The examination included clinical and instrumental methods: the changes in the clinical signs and symptoms, the dyspnea index (according to the mМRS scale), the saturation of hemoglobin with oxygen (SaO2), spirometry, heart rate variability, the frequency and nature of arrhythmias, and systolic and diastolic blood pressure (BP).Results. A sympathicotonic disorder of the autonomic balance was revealed in patients with exacerbation of COPD of the spirometry grades III – IV. This tendency intensified in the patients with concomitant hypertension, which indicated an additional negative effect of comorbid hypertension on the studied parameters. Aggravation of sympathicotonia could be a trigger for an increase in ectopic rhythm disturbances, including high-grade ventricular extrasystoles. In the groups with concomitant hypertension, rhythm disturbances were more frequent (p < 0.05). The inclusion of FCLB in the complex therapy of exacerbation of COPD of the spirometry grades III – IV made it possible to improve the condition of patients significantly: to reduce the dyspnea index on the mМRS scale, increase SaО2 and FEV1 (p < 0.05), achieve clinical improvement in COPD faster and shorten the hospitalization period. As a result of the rapid and effective relief of exacerbation of COPD, the influence of pathogenic factors on the cardiovascular system in the examined patients decreased. The addition of FCLB to the treatment COPD with and without comorbid hypertension did not have a negative effect on heart rate variability, did not aggravate rhythm disturbances, and did not destabilize the BP.Conclusion. The positive clinical effects of the inclusion of FCLB in the complex therapy of exacerbation of COPD of the spirometry grades III – IV in patients with comorbid hypertension led to a decrease in shortness of breath, an improvement in respiratory functions, a decrease in tissue hypoxia and eliminated possible adverse events of this group of drugs.