[The combined drug ascoril in the treatment of patients with chronic obstructive pulmonary disease concurrent with coronary heart disease].

AIM: To evaluate the clinical efficacy of the combined drug ascoril (Glenmark, India) in patients with grade I-Ii chronic obstructive pulmonary disease (COPD) concurrent with coronary heart disease (CHD). SUBJECTS AND METHODS: Sixty patients, including 12 (20%) women and 48 (80%) men, aged 43 to 68 years (mean age 55.1 +9.9 years), with COPD were examined. The patients were divided into 2 groups. Group 1 used the combined broncholytic and expectorant drug ascoril and Group 2 took mucolytic agent ambroxol. The follow-up period was 7 days. RESULTS: On day 2 of ascoril treatment, all the patients showed a significant reduction in the intensity of cough that was completely relieved in 26 (87%) patients by treatment day 7. Prior to ascoril treatment, heart rate (HR) was 64.4+/-5.5 beats/min. A significant increase in HR to 72.7+/-10.1 beats/min was observed 20 min after the first drug intake (p < 0.05) and a decrease to 68.6+/-10.5 beats/min was seen after 60 min. On treatment day 7, HR was 63.0+/-6.5 beats/min, which was similar to that before ascoril treatment (p = 0.6). CONCLUSION: In the patients with COPD concurrent with CHD, the combined drug ascoril exerts broncholytic and expectorant effects, with no pronounced negative action on HR.

[Assessment of therapeutic equivalence of original bisoprolol and its generics in patients with ischemic heart disease with concomitant chronic obstructive pulmonary disease].

Therapeutic equivalence of original bisoprolol (Concor) and its two generics (Biprol and Biol) was studied in 102 patients with ischemic heart disease (IHD) combined with chronic obstructive pulmonary disease (COPD). Concor, Biprol and Biol were given for 12 weeks to 36, 36, and 30 patients, respectively. Methods comprised test with endothelium dependent vasodilation, 24-hour ECG monitoring, pulmonary ventilation tests, and measurement of blood concentrations of nitrous oxide metabolites. Hypotensive and antiischemic effects were similar in all groups. However significant improvement of endothelial function occurred only among Concor treated patients. No negative changes of parameters of pulmonary ventilation took place after 4 weeks of therapy but after 12 weeks their significant lowering was observed among Biprol treated patients. We conclude that in this study on patients with IHD and COPD original bisoprolol demonstrated higher clinical efficacy and better tolerability than its generics.

[Echocardiography with physical exercise in patients with stable angina pectoris concurrent with chronic obstructive pulmonary disease: safety, informative value, and performance conditions].

AIM: To define the safety, informative value, and performance conditions of exercise echocardiography (EchoCG) in patients with stable angina (SA) concurrent with chronic obstructive pulmonary disease (COPD). SUBJECTS AND METHODS: Forty patients aged 45 to 66 years (mean age 54.8 +/- 4.9 years) with Functional Class (FC) II-III SA concurrent with COPD and 40 patients aged 46 to 65 years (mean 56.6 +/- 4.9 years) with FC II-III SA without COPD were examined. All the patients underwent exercise EchoCG during the chosen therapy. RESULTS: Exercise EchoCG is safe in patients with SA with COPD. To enhance the informative value of this test and to achieve the ischemic threshold in patients of this category require the use of adequate bronchodilator therapy. In this case, the informative value of the technique is 75%. CONCLUSION: Exercise EchoCG in patients with SA concurrent with COPD may serve as a reliable tool in determining exercise endurance during antianginal, bronchodilator therapy and in assessing its adequacy.

[Endothelial dysfunction in patients with combined coronary heart disease and chronic obstructive pulmonary disease].

The aim of this work was to evaluate functional incompetence of endothelium in patients with chronic coronary heart disease (CHD, stable angina) combined with chronic obstructive pulmonary disease and to choose the most informative method for the diagnosis of endothelial dysfunction. A total of 103 patients aged 36-66 (mean 57.2 +/- 7.6) years were examined. Group 1 comprised 38 patients with CHD and concomitant chronic obstructive pulmonary disease (COPD). Group 2 included 36 patients with stable angina alone, group 3 consisted of 29 patients with COPD without CHD. Attention is focused on the characteristic of endothelial function by instrumental and laboratory methods. Comparative analysis of the severity of endothelial dysfunction in patients of the three groups revealed different mechanisms of plasma nitrogen oxide dynamics in patients with CHD and/or COPD. CHD and COPD caused mutual aggravation (potentiation) of pathological reactions leading to the development of the disease. Blood levels of nitrogen oxide metabolites in patients with cardiovascular problems or with COPD alone did not reflect the actual amount of "vasodilatory" NO. Reactive hyperemia test is believed to be the most informative method for the assessment of endothelial function in patients with CHD and COPD.

[Efficacy of therapy with bisoprolol and ivabradine in patients with ischemic heart disease combined with chronic obstructive pulmonary disease assessment of parameters of 24-hour ECG monitoring].

Effect of therapy with 1-adrenoblocker bisoprolol and inhibitor of If channels ivabradine on parameters of 24-hour ECG monitoring (24hECGM) was studied in 64 patients with ischemic heart disease (stable angina) and chronic obstructive pulmonary disease (COPD). At the first stage all patients received bisoprolol. Parameters of external respiration function (ERF) and 24h ECG were registered before and after 4 months of bisoprolol administration. At stage 2 indications were determined for inclusion of ivabradine in the treatment scheme. At the background of therapy with bisoprolol we obtained significant lowering of heart rate (HR) both during day and night, as well as significant diminution of magnitude and duration of ischemic ST depression. In 44% of patients target HR range was not achieved. This conditioned the necessity to administer ivabradine. Therapy of patients with stable angina and concomitant COPD should begin with cardioselective -adrenoblockers (bisoprolol). Incorporation of inhibitor of If channels ivabradine in the treatment scheme is indicated if during treatment with -adrenoblockers average 24 hour HR according to data of 24hECGM exceeds 70 beats/min and deterioration of bronchial conductance according to ERF data occurs.

[Effects of beta 1-adrenoblocker bisoprolol on endothelial dysfunction in patients with stable angina pectoris in combination with chronic obstructive pulmonary disease].

AIM: To study effects of a cardioselective beta-adrenoblocker bisoprolol on vascular wall endothelium and external respiration function in stable angina of effort combined with chronic obstructive pulmonary disease (COPD). MATERIAL AND METHODS: Endothelial function and external respiration were studied before and after 4-week treatment with bisoprolol in 36 patients with stable angina and COPD using assessment of endothelium-dependent vasodilatation (EDVD) and concentrations of nitric oxide metabolites. RESULTS: Significant improvement of endothelial function was achieved due to bisoprolol 4-week treatment which did not affect external respiration function. CONCLUSION: Bisoprolol is effective and safe drug in the treatment of stable angina combined with COPD. It can noticeably improve endothelial function.

[Clinicofunctional characteristics of the heart in patients with stable angina pectoris in combination with chronic obstructive pulmonary disease].

AIM: To specify clinicofunctional characteristics of the heart in patients with stable angina in combination with chronic obstructive pulmonary disease (COPD). MATERIAL AND METHODS: A total of 125 anginal patients with COPD were devided into three groups. The study group consisted of 80 patients (48 males and 32 females) aged 53.10+/-0.83 years with angina of effort (AE) offunctional class (FC) II-III and mild to moderate COPD. Control group 1 consisted of 23 patients with FC II-IIIAE, control group 2--of 22 COPD patients. The examination included doppler-echocardiography (DECG), 24-h ECG monitoring (ECGM), selective coronarography, assessment of external respiration function (ERF), lipid metabolism and blood gases. RESULTS: Patients with AE of FC II-III and COPD complain of dysonea and palpitation, their 24-h DECG registered arrhythmia and asymtomatic ischemic heart disease more frequently than in the controls, their systolic and diastolic left ventricular dysfunction is more serious. CONCLUSION: AE patients with COPD should undergo a comprehensive examination including DECG, 24-h ECGM, assessment of ERF and blood gases for early detection of various disorders and administration of adequate treatment.