Key result
Inhalation of tiotropium in a 77-year-old man with COPD and CHF improved pulmonary function and safely ameliorated CHF signs, reducing plasma BNP from 252 pg/ml to 56 pg/ml.
Why the study?
Does tiotropium improve symptoms and hemodynamics in a patient with COPD complicated by CHF?
Case Report (n=1)
No
Does tiotropium improve symptoms and hemodynamics in a patient with COPD complicated by CHF?
Tiotropium safely improved both respiratory symptoms and heart failure hemodynamics (BNP, LVEDP) in a patient with coexisting COPD and CHF.
Hypothesis-generating for tiotropium in COPD-CHF overlap; randomized trials needed before any practice consideration.
A 77-year-old man was referred to hospital because of dyspnea on exertion. Although the patient had been fully medicated for chronic heart failure (CHF) caused by hypertensive heart disease, the echo-estimated left ventricular end-diastolic pressure (LVEDP) and brain natriuretic peptide (BNP) level had continued to be high for at least 2 years. Pulmonary functional examination revealed concomitant chronic obstructive pulmonary disease (COPD). Because beta-agonists were expected to exacerbate the CHF, inhalation of tiotropium, a non-beta-adrenergic bronchodilator and novel M3 muscarinic receptor antagonist, was used to treat the COPD. Not only did the pulmonary function improved but the treatment also safely ameliorated CHF signs including LVEDP and plasma BNP.
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Kato et al. (2006) conducted a case report in Chronic Obstructive Pulmonary Disease complicated by Chronic Heart Failure (n=1). Tiotropium vs. Baseline was evaluated on Plasma BNP level (pg/ml). Inhalation of tiotropium in a 77-year-old man with COPD and CHF improved pulmonary function and safely ameliorated CHF signs, reducing plasma BNP from 252 pg/ml to 56 pg/ml.
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