Certain bronchodilators can increase cardiovascular risks in COPD patients

Physicians should begin long-acting bronchodilators with caution, according to a new study that associated the treatment with an increased risk of cardiovascular disease in patients with chronic obstructive pulmonary disease (COPD).

Meng-Ting Wang, PhD, lead author of the study and associate professor in the school of pharmacy at the National Defense Medical Center in Taiwan said his team identified an increase in the risk of cardiovascular disease (CVD) in as little as a month with new use of inhaled long-acting β₂-agonist (LABA) and long-acting muscarinic antagonist (LAMA) in COPD patients.

“Overall, there is an approximately 1.5-fold and 1.52-fold increased risk of CVD associated with new use of LABA and LAMA, respectively, in patients with COPD within 30 days of the inhalation therapy,” Wang told Medical Economics. “Specifically, the CVD risk peaked on the 30th day of starting the treatment, and gradually reduced but remained significant between 31 to 60 days of therapy.”

The study, published Jan. 2, 2018, in JAMA Internal Medicine, investigated the effect on these bronchodilators in nearly 40,000 COPD patients over a two-year period. The results highlight the need for clinicians to monitor patients new to LABAs or LAMAs in order to avoid or manage cardiovascular disease risks spurred by these medications, he said. Additionally, the research makes it clear that clinicians should regularly assess COPD patients for general cardiovascular health before prescribing long-acting bronchodilators, Wang added. These assessments should include heart rate measurements and electrocardiograms. Patients should be instructed to share any cardiac symptoms with their clinician, particularly when treatment is initiated, and to seek medical attention as soon as possible if symptoms do develop. However, Wang said patients should also be warned not to stop inhalation medications without consulting with their clinician first.

Overall, Wang said while LABAs and LAMAs are valuable in the treatment of COPD, some caution must be taken.

“Inhaled LABA and LAMA are presently the mainstay therapy for treatment of COPD. Through an inhalation route, these medications can improve lung function, ameliorate COPD symptoms and increase health-related quality of life in COPD patients,” Wang said. “Given LABA and LAMA are the only available inhaled long-acting bronchodilators to COPD patients, despite other available oral bronchodilators, our observed cardiovascular risk associated with LABA and LAMA needs to be taken into account when optimizing the inhalation therapy in COPD.”

Wang hopes future studies are developed to examine what other factors or conditions may make some patients with COPD taking LABAs or LAMAs more susceptible to developing cardiovascular disease than others.