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Sep 3, 2018

ERC congress - Resuscitation 2018

6 - Evaluation of cardiovascular safety of patients with chronic obstructive lung disease using base therapy






Relevance of the topic. According to national and international standards, patients with chronic obstructive pulmonary disease (COPD) should take long-term and planned basic therapy, since the disease is a chronic pathology with, unfortunately, a steady progression. Beginning with Stage II of COPD, patients should receive continuous long-acting bronchodilators (long-acting beta-2-agonists (BADD) or long-acting cholinolytics (CLDD)), and from stage III, inhaled glucocorticosteroids (IGCC). It is known that the aforementioned drugs can influence the formation of the pathology of the cardiovascular system, in particular, leading to a disturbance of the heart rhythm and / or affecting the level of arterial pressure (AP). In connection with the foregoing, the purpose of our study was to assess the presence and severity of arterial hypertension (AH) in patients with COPD with prolonged use of basic therapy. The main group included 20 COPD patients (mean age 68.5 ± 2.56 years, men 17 (85.0%), women 3 (15.0%), pack / year index 44.5 ± 7, 04, duration of COPD - 14.6 ± 2.92 years). The diagnosis of COPD was made according to the order of the Ministry of Health of Ukraine No. 555 of 27.06.2013. All the examined patients were compliant and for a period of more than 10 years they constantly took scheduled therapy in the form of combined IGKS / BADD (fluticasone propionate / salmeterol (250/25 μg) 2 inhalation doses twice a day and if necessary a short-acting beta-agonist salbutamol (100 mcg) for 2 inhalation doses per reception). At the stage of inclusion of patients in the study, all were assessed clinical symptoms, general clinical methods of investigation, the degree of ventilation disorders according to spirometry and the parameters of daily monitoring of blood pressure. Clinical symptoms was assessed by the expressiveness of COPD symptoms in general using the COPD Assessment Test (COPD Assessment Test). The CAT score, less than 10 was interpreted as a "small number of COPD symptoms", more than 10 as "a large number of symptoms COPD. " A study of lung ventilation with determination of the levels of indices (forced vital capacity of lungs (FVC), volume of forced expiration in the first second (FEV1) and their ratio FEV1 / FVC) was carried out by computer spirometry. The bronchial obstruction reversibility test was performed with 400 mcg of salbutamol. All indicators were calculated as a percentage of the proper values. Statistical processing of the obtained results was carried out with the help of the general package of functions "MS Exel". Results and their discussions. The analysis of the obtained results showed that at the time of inclusion of patients in the study they all had a rather high expressiveness of clinical symptoms (according to SAT - 14.9 ± 1.05 points) and severe bronchial obstruction (level of FEV1 in the post-sample - 51.3 ± 2, 81% of the proper value). According to international recommendations (GOLD, 2018) and taking into account the number of exacerbations of COPD in the last year (in all - more than 2 exacerbations), all the patients we examined were assigned to the clinical group "D". According to the survey of patients it was found that 14 (70.0%) of them had AH for a long time (14.7 ± 1.05 years), with 9 (64.2%) permanently taking scheduled antihypertensive therapy; five patients (35.7%), although they knew about their existing AH, did not take any medications on schedule. Six patients (30.0%) were absent according to the AH survey, but according to AO-monitoring data it was found that three of them (50.0%) still had hypertension, which they did not even guess (Figure 1) . Fig. 1. Distribution of patients with COPD, depending on the presence of hypertension and the relationship to treatment Thus, all patients with AH on the background of COPD (17 (85.0%)) were divided into two subgroups: subgroup 1-9 (52.9%), treated with AH, subgroup 2-8 (47, 1 %) of individuals, did not treat hypertension. The results of AT monitoring are given in Table. 1.Conclusions. 1. Patients with COPD in more than 80% of cases have a combined comorbid pathology as an AH. 2. Almost half of patients with COPD with combined AH do not receive routine AH therapy. 3.Almost one in three COPD patients can not be tied to medical care or treatment of hypertension (most often, due to the need to spend most of their material funds on the treatment of primary bronchial obstructive pathology). Moreover, even those patients who "treat hypertension" do not achieve improvement in blood pressure levels (most likely, due to inadequate drug options). 4. Patients with COPD are a group of special attention on the part of not only pulmonary physicians, but also cardiologists.

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© Copyright 2019 Morressier GmbH.
All rights reserved.