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Pulmonale Effekte kardialer Therapie und vice versa

Pulmonary effects of cardiac therapy and vice versa

  • Leitthema
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Der Pneumologe Aims and scope

Zusammenfassung

Eine Komorbidität pulmonaler und kardialer Erkrankungen ist häufig. Die erfolgreiche Arzneimitteltherapie setzt in diesen Fällen die Kenntnis der unerwünschten Effekte der verwendeten Wirkstoffe auf das jeweils andere Organsystem voraus.

Bei der Therapie der chronisch obstruktiven Lungenerkrankung (COPD) können unerwünschte kardiale Wirkungen durch Theophyllin (Arrhythmien) oder inhalative β2-Sympathomimetika (Tachykardien, Hypokaliämie) auftreten. Kürzlich wurde auch eine kardiale Übersterblichkeit bei Therapie mit inhalativen Anticholinergika (insbesondere Ipratropiumbromid) diskutiert. Bei der Therapie von KHK oder Linksherzinsuffizienz sind unerwünschte Wirkungen auf die Lunge zu beachten, wenn Acetylsalicylsäure (pseudoallergisches Syndrom), ACE-Hemmer (Husten, angioneurotisches Ödem) oder Amiodaron (pulmonale Toxizität) eingesetzt werden. Gerade bei Patienten mit COPD ist der Nutzen von kardioselektiven β-Blockern bei akutem Koronarsyndrom oder Linksherzinsuffizienz trotz des möglichen Risikos von Bronchospasmen in Studien belegt.

Zumeist existieren Alternativen im Falle von Kontraindikationen bzw. Strategien zur Therapieanpassung beim Auftreten unerwünschter Wirkungen.

Abstract

Cardiac and pulmonary disease commonly present as comorbidities. Thus, pharmacotherapy will be successful only if based on thorough knowledge of the drugs’ potential adverse effects on the other organ system.

Treatment of chronic obstructive pulmonary disease (COPD) may cause adverse cardiac effects when theophylline (arrhythmia) or inhalational β-adrenergic receptor agonists (tachycardia, hypokalaemia) are used. Moreover, recent evidence suggests an elevated risk of death from cardiovascular cause during treatment with inhalational anticholinergics (ipratropium bromide). When treating coronary heart disease or left heart failure, adverse effects on the lung should be taken into consideration, namely for ASS (pseudoallergic syndrome), ACE inhibitors (cough, angioneurotic oedema), and amiodarone (pulmonary toxicity). Patients with COPD and acute coronary syndrome or left heart failure benefit from cardioselective β-blockers despite the possible risk of bronchospasm.

Alternative substances or strategies often exist for modifying therapy and managing adverse effects.

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  1. Medizinische Klink III – Kardiologie, Angiologie und Pneumologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Deutschland

    C. Göggelmann, A. Filusch & F.J. Meyer

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  1. C. Göggelmann
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  2. A. Filusch
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  3. F.J. Meyer
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Correspondence to C. Göggelmann.

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Göggelmann, C., Filusch, A. & Meyer, F. Pulmonale Effekte kardialer Therapie und vice versa. Pneumologe 6, 399–404 (2009). https://doi.org/10.1007/s10405-009-0325-1

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