CHEST Guidelines-Long-Acting-Bronchodilators-and-Arterial-Stiffness

Long-Acting-Bronchodilators-and-Arterial-Stiffness

Pdf Summary

The study published in <em>CHEST</em> investigates the impact of two long-acting bronchodilators, fluticasone furoate/vilanterol (FF/VI) and tiotropium bromide (TIO), on arterial stiffness in patients with Chronic Obstructive Pulmonary Disease (COPD). Arterial stiffness, measured by aortic pulse wave velocity (aPWV), is a predictor of cardiovascular events and mortality, and is often elevated in individuals with COPD. The study included 257 patients with a baseline aPWV of at least 11 m/s, most of whom also had a history of cardiovascular events or risks. 

Conducted as a multicenter, randomized, 12-week trial, the primary goal was to assess changes in aPWV from baseline after treatment with once-daily doses of FF/VI (100/25 mcg) or TIO (18 mcg). The study found no significant difference in aPWV reduction between the two treatments. However, both treatments demonstrated a decrease of approximately 1 m/s from baseline levels, suggesting potential clinically meaningful effects, although the absence of a placebo group prevents definitive conclusions.

Safety assessments showed similar adverse event rates for both treatments, where the most reported side effects were COPD exacerbation, nasopharyngitis, and headaches. Long-term safety, especially concerning cardiovascular events linked with long-acting muscarinic antagonists and LABAs, was suggested for further research, considering cardiovascular comorbidities prevalent in the study population.

The research concludes that while there were no significant differences between FF/VI and TIO effects on aPWV, potential improvements call for further placebo-controlled studies. Both bronchodilators were well-tolerated over the trial's 12-week duration, which is pivotal considering the frequent cardiovascular comorbidities in the COPD population. This study emphasizes the need for more robust trials to explore long-term cardiovascular impacts and the broader implications of bronchodilator use in COPD management.

Keywords

COPD

arterial stiffness

fluticasone furoate

vilanterol

tiotropium bromide

aortic pulse wave velocity

cardiovascular events

bronchodilators

multicenter trial

placebo-controlled