β-受体阻滞剂治疗慢性阻塞性肺疾病：一项来自TONADO®研究项目的队列研究
2018/05/30
摘要
背景：心血管疾病在慢性阻塞性肺疾病（COPD）患者中是一种常见的并发症。许多临床医师，特别是呼吸科医师，尽管已经有证据证实了预防心血管事件的有效性，但仍不愿意在COPD患者中使用β-肾上腺素受体阻断剂。
方法：大型（5,162例）III期TONADO®研究评估了接受长效支气管扩张剂治疗1年以上的中、重度COPD患者的肺功能和患者报告的临床结局（PROs）情况。这项事后分析对研究中接受了β受体阻滞剂的亚组患者的肺功能变化，PROs和安全性进行了逐一分析。
结果：总共有557 / 5,162名患者（11％）在基线时接受了β受体阻滞剂治疗。与未接收β受体阻滞剂组相比，β受体阻滞剂组的使用支气管扩张剂后的FEV1较高（1.362 L vs 1.470 L）。正如预期的那样，β受体阻滞剂组的患者有较多的心血管并发症和药物治疗史。在24或52周时，未观察到两组患者的基线肺功能改善情况有明显差异。β受体阻滞剂组患者的圣乔治呼吸问卷(SGRQ)评分和过渡期呼吸困难指数与未使用β受体阻滞剂组的患者相比，差异无统计学意义。两组之间的安全性结果相当。
结论：基线β受体阻滞剂治疗对中重度COPD患者的肺功能，总体呼吸状态和安全性没有影响。来自这一大型患者队列的结果支持COPD同时存在心血管并发症的患者可以慎用β-阻滞剂。
β-blockers in Chronic Obstructive Pulmonary Disease: a Cohort Study from the TONADO® Research Programme
François Maltais, MD , Roland Buhl, MD, Andrea Koch, MD, Valeria C. Amatto, MD, MSc, Jim Reid, MBChB DipObs, FRNZCGP, FCCP, MPS, Lars Grönke, MD, Ulrich Bothner, MD, MSc
Abstract
Background：Cardiovascular disease is a frequent co-morbidity in patients with chronic obstructive pulmonary disease (COPD). Many clinicians, particularly pulmonologists, are reluctant to use β-adrenoceptor blocking agents (β-blockers) in patients with COPD, despite their proven effectiveness in preventing cardiovascular events.
Methods：The large (5,162 patients) phase III TONADO® 1 and 2 studies assessed lung function and patient-reported outcomes (PROs) in patients with moderate to very severe COPD receiving long-acting bronchodilator treatment over 1 year. This post hoc analysis characterised lung-function changes, PROs and safety in the subgroup of patients receiving β-blockers in the studies.
Results：total, 557/5,162 patients (11%) received β-blockers at baseline. Post-bronchodilator FEV1 at baseline was higher in the β-blocker group (1.470 L) compared to the no β-blocker group (1.362 L). As expected, patients on β-blockers had a more frequent history of cardiovascular co-morbidities and medications. Lung function improved from baseline in patients with or without β-blocker treatment, and no relevant between-group differences were observed in trough FEV1 or trough FVC at 24 or 52 weeks. No relevant differences were observed for SGRQ and Transition Dyspnoea Index in patients with β-blockers compared to those without. Safety findings were comparable between groups.
Conclusions：Lung function, overall respiratory status and safety of tiotropium/olodaterol were not influenced by baseline β-blocker treatment in patients with moderate to very severe COPD. Results from this large patient cohort support the cautious and appropriate use of β-blockers in patients with COPD and cardiovascular co-morbidity.
背景：心血管疾病在慢性阻塞性肺疾病（COPD）患者中是一种常见的并发症。许多临床医师，特别是呼吸科医师，尽管已经有证据证实了预防心血管事件的有效性，但仍不愿意在COPD患者中使用β-肾上腺素受体阻断剂。
方法：大型（5,162例）III期TONADO®研究评估了接受长效支气管扩张剂治疗1年以上的中、重度COPD患者的肺功能和患者报告的临床结局（PROs）情况。这项事后分析对研究中接受了β受体阻滞剂的亚组患者的肺功能变化，PROs和安全性进行了逐一分析。
结果：总共有557 / 5,162名患者（11％）在基线时接受了β受体阻滞剂治疗。与未接收β受体阻滞剂组相比，β受体阻滞剂组的使用支气管扩张剂后的FEV1较高（1.362 L vs 1.470 L）。正如预期的那样，β受体阻滞剂组的患者有较多的心血管并发症和药物治疗史。在24或52周时，未观察到两组患者的基线肺功能改善情况有明显差异。β受体阻滞剂组患者的圣乔治呼吸问卷(SGRQ)评分和过渡期呼吸困难指数与未使用β受体阻滞剂组的患者相比，差异无统计学意义。两组之间的安全性结果相当。
结论：基线β受体阻滞剂治疗对中重度COPD患者的肺功能，总体呼吸状态和安全性没有影响。来自这一大型患者队列的结果支持COPD同时存在心血管并发症的患者可以慎用β-阻滞剂。
(中日友好医院呼吸与危重症医学科 王圆方 摘译 林江涛 审校)
(Chest，Available online 31 January 2018)
(Chest，Available online 31 January 2018)
β-blockers in Chronic Obstructive Pulmonary Disease: a Cohort Study from the TONADO® Research Programme
François Maltais, MD , Roland Buhl, MD, Andrea Koch, MD, Valeria C. Amatto, MD, MSc, Jim Reid, MBChB DipObs, FRNZCGP, FCCP, MPS, Lars Grönke, MD, Ulrich Bothner, MD, MSc
Abstract
Background：Cardiovascular disease is a frequent co-morbidity in patients with chronic obstructive pulmonary disease (COPD). Many clinicians, particularly pulmonologists, are reluctant to use β-adrenoceptor blocking agents (β-blockers) in patients with COPD, despite their proven effectiveness in preventing cardiovascular events.
Methods：The large (5,162 patients) phase III TONADO® 1 and 2 studies assessed lung function and patient-reported outcomes (PROs) in patients with moderate to very severe COPD receiving long-acting bronchodilator treatment over 1 year. This post hoc analysis characterised lung-function changes, PROs and safety in the subgroup of patients receiving β-blockers in the studies.
Results：total, 557/5,162 patients (11%) received β-blockers at baseline. Post-bronchodilator FEV1 at baseline was higher in the β-blocker group (1.470 L) compared to the no β-blocker group (1.362 L). As expected, patients on β-blockers had a more frequent history of cardiovascular co-morbidities and medications. Lung function improved from baseline in patients with or without β-blocker treatment, and no relevant between-group differences were observed in trough FEV1 or trough FVC at 24 or 52 weeks. No relevant differences were observed for SGRQ and Transition Dyspnoea Index in patients with β-blockers compared to those without. Safety findings were comparable between groups.
Conclusions：Lung function, overall respiratory status and safety of tiotropium/olodaterol were not influenced by baseline β-blocker treatment in patients with moderate to very severe COPD. Results from this large patient cohort support the cautious and appropriate use of β-blockers in patients with COPD and cardiovascular co-morbidity.
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伴或不伴哮喘的成人中血嗜酸性粒细胞计数和肺功能下降的相关性
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漏诊和过度诊断COPD对医疗卫生服务造成的负担
