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Medikamentöse Therapie von Herz- und Lungenerkrankungen

Effekte auf das jeweils andere Organ

Medical therapy of heart and lung diseases

Effects on the respective other organ

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Zusammenfassung

Viele Patienten sind gleichzeitig herz- und lungenkrank. Die Wahl der medikamentösen Therapie richtet sich nicht nur nach der klinischen und prognostischen Wirksamkeit am Zielorgan, sondern auch nach den Effekten am jeweils anderen Organ. Betablockern und Statinen werden sowohl günstige wie auch potenziell ungünstige Wirkungen an der Lunge zugeschrieben. ACE-Hemmer und Amiodaron gehen recht häufig mit pneumologischen Komplikationen einher. Niedrig dosierte Thiaziddiuretika und Kalziumantagonisten werden zur Therapie hypertensiver Asthmatiker empfohlen. Betablocker sollten hier vermieden werden. Theophyllin sollte bei kardial vorerkrankten Patienten nur mit Zurückhaltung verordnet werden. Glukokortikosteroide können kardiovaskuläre Symptome verursachen, während der Phosphodiesterase-4-Hemmer Roflumilast keine ungünstigen kardiovaskulären Wirkungen zu haben scheint. Für Anticholinergika sind günstige wie ungünstige Effekte auf das Herz-Kreislauf-System beschrieben. Insbesondere kurz wirksame Beta-2-Sympathomimetika (SABA) und Makrolide können Herzrhythmusstörungen triggern, und für einige SABA wird eine erhöhte Herzinfarktrate berichtet. Das Wissen um die Wirkungen der für pneumologische und kardiovaskuläre Erkrankungen notwendigen Medikamente am jeweils anderen Organ und um die damit verbundenen Komplikationen und Langzeitwirkungen ist notwendig, um die vielen gleichzeitig herz- und lungenkranken Patienten optimal zu therapieren.

Abstract

Many patients suffer from both heart and lung diseases. The choice of medical drugs should not only be driven by the clinical and prognostic effects on the target organ but should also be selected based on the effects on the respective other organ. Beta blockers and statins have both beneficial and harmful effects on the respiratory system. Angiotensin-converting enzyme (ACE) inhibitors and amiodarone can cause severe lung damage. Low-dose thiazides and calcium antagonists are first-line medications in hypertensive asthma patients but beta blockers should be avoided. Theophyline should be used with caution in patients with known cardiac disease. Glucocorticosteroids can cause cardiovascular symptoms while the phosphodiesterase inhibitor roflumilast appears to have no relevant cardiovascular side effects. Anticholinergic drugs have both favorable and unfavorable cardiovascular (side) effects. Short-acting beta-2 sympathomimetic drugs (SABA) and macrolides in particular can trigger arrhythmia and some SABAs are associated with a higher incidence of myocardial infarction. Detailed knowledge of the effects of drugs used for the treatment of lung and heart diseases on the respective other organ and the associated complications and long-term effects are essential in providing optimal medical care to the many patients who present with both respiratory and cardiovascular diseases.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. S. Möhlenkamp, G. Weinreich, T. Neumann, T. Voshaar und H. Teschler geben an, dass kein Interessenkonflikt besteht.

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  1. Klinik für Kardiologie, Angiologie und Internistische Intensivmedizin, Krankenhaus Bethanien, Moers, Deutschland

    S. Möhlenkamp

  2. Abteilung Pneumologie, Ruhrlandklinik, Westdeutsches Lungenzentrum, Universitätsklinikum Essen, Universität Duisburg-Essen, Tüschener Weg 40, 45239, Essen, Deutschland

    G. Weinreich &  H. Teschler

  3. Klinik für Kardiologie, Westdeutsches Herzzentrum Essen, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Deutschland

    T. Neumann

  4. Klinik für Pneumologie, Allergologie und Schlafmedizin, Krankenhaus Bethanien, Moers, Deutschland

    T. Voshaar

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  1. S. Möhlenkamp
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Möhlenkamp, S., Weinreich, G., Neumann, T. et al. Medikamentöse Therapie von Herz- und Lungenerkrankungen. Herz 39, 15–24 (2014). https://doi.org/10.1007/s00059-013-4035-4

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