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Lung function with carvedilol and bisoprolol in chronic heart failure: Is β selectivity relevant?
Author(s) -
Agostoni Piergiuseppe,
Contini Mauro,
Cattadori Gaia,
Apostolo Anna,
Sciomer Susanna,
Bussotti Maurizio,
Palermo Pietro,
Fiorentini Cesare
Publication year - 2007
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1016/j.ejheart.2007.04.006
Subject(s) - bisoprolol , carvedilol , medicine , salbutamol , heart failure , cardiology , bronchodilator , pharmacology , anesthesia , asthma
Abstract Background Carvedilol is a β‐blocker with similar affinity for β 1 ‐ and β 2 receptors, while bisoprolol has higher β 1 affinity. The respiratory system is characterized by β 2 ‐receptor prevalence. Airway β receptors regulate bronchial tone and alveolar β receptors regulate alveolar fluid re‐absorption which influences gas diffusion. Aims To compare the effects of carvedilol and bisoprolol on lung function in patients with chronic heart failure (CHF). Methods and results We performed a double‐blind, cross‐over study in 53 CHF patients. After 2 months of full dose treatment with either carvedilol or bisoprolol, we assessed lung function by salbutamol challenge, carbon monoxide lung diffusion (DL CO ), including membrane conductance (DM), and gas exchange during exercise. FEV 1 and FVC were similar; after salbutamol FEV 1 was higher with bisoprolol ( p <0.04). DL CO was 82±21% of predicted with carvedilol and 90±20% with bisoprolol ( p <0.01) due to DM changes. Peak VO 2 was 17.8±4.5 mL/min/kg on bisoprolol and 17.0±4.6 on carvedilol, ( p <0.05) with no differences in bronchial tone (same expiratory time) throughout exercise. Differences were greater in the 22 subjects with DL CO <80%. Conclusion Carvedilol and bisoprolol have different effects on DL CO and response to salbutamol. DL CO differences, being DM related, are due to changes in active membrane transport which is under alveolar β 2 ‐receptor control. Peak VO 2 was slightly higher with bisoprolol particularly in CHF patients with reduced DL CO .