CHRONIC HEART FAILURE OF ISCHEMIC GENESIS AND CHRONIC OBSTRUCTIVE PULMONARY DISEASE: POSSIBILITIES OF COMBINATION THERAPY INCLUDING NEBIVOLOL

Objective: to reveal the features of chronic heart failure (CHF) of ischemic genesis concurrent with chronic obstructive pulmonary disease (COPD) and to investigate the effect of the cardioselective β1-adrenoblocker (β1-AB) nebivolol on the course of COPD and the parameters of the bronchopulmonary system in patients with CHF of ischemic genesis during treatment.

Subjects and methods.The investigation enrolled 63 patients aged 40–70 years, including 43 patients with functional class (FC) II–IV CHF with a Simpson left ventricular ejection fraction of  45 % concurrent with COPD (a study group) and 20 patients with CHF and no bronchopulmonary pathology (a control group). The study group patients were randomly divided into 2 subgroups: 1) 23 patients who received nebivolol in addition to background therapy; 2) 20 patients in whom the therapy ruled out the use of β1-AB. The control patients were switched to nebivolol therapy. During 6-month follow-up, the authors made clinical examination, recorded the rate, duration, and severity of COPD exacerbations, performed a 6-minute walking test (6MWT), and used a clinical status scale modified by R. Cody, a dyspnea 0–10 category ratio (Borg scale), and a Medical Research Council Dyspnoea Scale (MRS scale). Besides, quality of life in patients was assessed using the specific Minnesota Living with Heart Failure Questionnaire. All the patients underwent echocardiography, bronchodilatation-induced external respiratory function test, peak flowmetry, and blood brain natriuretic peptide quantification. These studies were conducted at baseline and at 1 and 6 months of therapy.

Results. During the investigation, the patients with CHF concurrent with COPD were found to have a high rate of hypertensive disease, prior myocardial infarctions, atrial fibrillations, and higher FC exertional angina. These patients also showed a delayed optimal result achievement during the combination therapy involving the use of β1-AB. The group of patients without concomitant COPD was observed
to have lower FV CHF and significantly reduced dyspnea during exercise (Borg scale) immediately following 1-month therapy whereas these were seen only after 6 months. Nebivolol (mean dose 5 mg) included in the treatment regimen for patients with CHF concurrent with COPD failed to have a significant effect on spirometric and peak flowmetric readings, but had a clear-cut positive effect on the health indicators of CHF patients, such as FC of the disease, heart rate, 6MWT distance, degree of dyspnea degree, and quality of life.

Conclusion. Combination cardiopulmonary therapy including β1-AB leads to more effective control of comorbidity symptoms and to improvement
of patient functional status.

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