Failing heart--medical aspectsTolerability of carvedilol in patients with heart failure and concomitant chronic obstructive pulmonary disease or asthma
Section snippets
Patient population
From 1996 to 2000, a total of 487 patients began receiving open-label carvedilol for treatment of New York Heart Association (NYHA) functional Class I to Class IV systolic chronic heart failure. All patients attended a heart failure clinic at one institution and had received heart failure therapy for at least 3 months before beginning carvedilol therapy. The only exclusion criteria to attempting to introduce carvedilol were cardiogenic shock, intractable pulmonary and systemic edema, heart
Results
Of the 43 patients, 31 had COPD and 12 had asthma. The patients were predominantly men (88%) with moderately severe heart failure, as shown by the baseline demographics in Table I .
Lung function in heart failure
The interpretation of restrictive and obstructive defects observed with pulmonary function testing in patients with heart failure is difficult when concomitant airway disease is present.5, 6, 7 Reversible obstructive defects have been described in acute cardiac failure, whereas a restrictive defect with reduced DLCO is more typical of chronic congestive cardiac failure. The range of mechanisms proposed for the restrictive pattern includes respiratory muscle weakness, reduced lung volume caused
Conclusion
A large number of patients with heart failure and COPD can, in fact, tolerate carvedilol therapy and achieve substantial cardiac benefits from the treatment. The maximum dose of carvedilol achieved, tolerability, and improvements in cardiac function and survival were similar to those seen in our previously described patients who received open-label carvedilol for treatment of heart failure.8, 15 Despite the small number of patients in our study, asthma with significant reversibility (defined as
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