Bronchodilator Therapy Improves Heart Function in COPD

Lung Deflation with Bronchodilator Therapy Helps Heart Function

Background: In those with COPD, it is common for the lungs to be over inflated with air. This is called lung hyperinflation.  This occurs because of narrowing of the

Chext xray shows excess air in the lungs (hyperinflation). The heart is smaller than norma.

Front view of chest xray shows hyperinflation. The heart is smaller than normal.

breathing tubes that limits the ability to get all of air out when exhaling. 

Lung hyperinflation makes it harder to breathe because the diaphragm muscle is “pushed down” and less effective as a breathing muscle. In addition, studies show that hyperinflation is associated with reduced size of the chambers of the heart and reduced ability of heart function.

Side view of the chest shows hyperinflation with the diaphragm muscle pushed down.

Side view of the chest shows hyperinflation with the diaphragm muscle pushed down.

 

 

 

Study: Dr. Ian Stone and colleagues at the London Chest Hospital treated 45 individuals with COPD who had lung hyperinflation. They were interested to see if deflating the lungs (like letting air out of a balloon) with an inhaled combination of a long-acting beta-agonist bronchodilator and an inhaled corticosteroid would improve heart function using a specialized test called cardiac magnetic resonance. Treatment was given once daily for 7 days. The study was published in the April 1, 2016, issue of the American Journal of Respiratory and Critical Care Medicine (volume 193, pages 717-726).

Results: Average age of the subjects was 64 years. 62% were men. Most individuals were short of breath walking on the level. The treatment with vilanterol and fluticasone furoate: 1) reduced lung hyperinflation as expected; 2) increased the size of the both the right and left ventricles (chambers) of the heart; 3) increased the amount of blood pumped out of the right ventricle.  

Chambers of the heart

Chambers of the heart

Conclusions: Opening the breathing tubes and allowing more air to be exhaled (called lung deflation) with inhaled therapy improved the ability of the heart to function. The authors cautioned that the long-term benefits are unclear.

My Comments: The results of this study show that standard inhaled medications used to treat shortness of breath and reduce the risk of a “flare-up” can also help the heart.  In my opinion, this provides even more support for treating those with COPD with both long-acting beta-agonist and muscarinic antagonist bronchodilators. This can be achieved by using one inhaler that contains both medications or two separate inhalers. Helping the lungs can also help the heart. I encourage you to share this information with your health care provider.