COPD and bronchodilators: should the heart pay the bill for the lung?

The pharmacological treatment of patients with coexisting cardiovascular disease (CVD) and chronic obstructive pulmonary disease (COPD) is challenging, because some drugs for COPD patients should be used with caution in patients with CVD, and vice versa . The crucial question on cardiovascular safety of long-acting bronchodilators, i.e. long-acting β2-agonists (LABAs) and long-acting anti-muscarinic agents (LAMAs, principally tiotropium), has no definitive answer. Because of different mechanisms of action, the combination of these drugs is expected to be more effective than the individual components in the maintenance treatment of COPD [1]. Evidence available from randomised controlled trails and observational studies on increased risk of cardiovascular adverse events is large but difficult to summarise because of complex methodology, different comparison groups and potential bias in each study [2–5]. Results are controversial and inconclusive. The risks of combining LABAs and tiotropium for the treatment of COPD are still unclear. Whether COPD patients treated with long-acting bronchodilators have increased risk of heart failure, or patients with both COPD and heart failure have higher risk of adverse events, remain open questions. Treatment with bronchodilators in COPD patients should take into account cardiovascular comorbidities