Bronchodilator responsiveness in patients with chronic heart failure

Objective: The aim of this study was to evaluate the effect of inhaled bronchodilators on pulmonary function and dyspnea in patients with chronic heart failure (HF). Background: Conflicting data exist on whether bronchodilators may improve pulmonary function and dyspnea in patients with chronic HF. Methods: In this retrospective observational study we analyzed data of 116 chronic HF outpatients with systolic dysfunction who underwent spirometry and Borg dyspnea measurements before, and after inhalation of 400 mu g salbutamol and 80 mu g ipratropium. Patients with chronic obstructive pulmonary disease (COPD) or asthma were excluded. Results: Bronchodilators fully reversed airway obstruction (AO) in 25 of 64 (39.1%) patients with pre-bronchodilator AO. All spirometric measurements, except for forced vital and inspiratory capacities, improved significantly post-bronchodilation. Absolute and percent improvements in forced expiratory volume in 1 s (FEV1) were more pronounced in patients with persistent AO post-bronchodilation compared to those without AO (0.19 +/- 0.18 L and 8.4 +/- 7.3% versus 0.11 +/- 0.12 L and 4.3 +/- 4.0%, p < 0.05). Significant bronchodilator responsiveness of FEV1 (>200 mL and >12%) was noted in 12.1% and was more frequent in patients with persistent AO and fully reversible AO than in those without AO (23.1% and 16.0% versus 1.9%, p < 0.05). We measured a small, albeit significant improvement in dyspnea (0.7 +/- 1.2 versus 0.9 +/- 1.3, p = 0.002). Conclusions: Inhaled bronchodilators may have an additional role in the management of patients with chronic HF because of their potential to improve pulmonary function, especially in those with AO. The clinical usefulness and possible adverse events of bronchodilators need to be further established. (C) 2013 Elsevier Inc. All rights reserved.