The role of beta-agonist therapy for chronic obstructive airway disease in patients with coexistent atrial fibrillation

Background: New advances have been made in medicine, but the incidence and prevalence of chronic obstructive pulmonary disease (COPD) are evident, and it is established as the fourth cause of death in the United States representing a high cost for the healthcare system. This condition has been related to atrial fibrillation due to the changes in the lungs and vasculature. Based on this history, we seek to evaluate the outcome of AF in the patients with COPD and its relationship with medical therapy utilized to treat this pulmonary condition with the objective of establishing the relationship between the use of beta-agonist therapy for obstructive airway disease in patients with AF. Discussion: Cell receptors participate in multiple reactions and the sympathetic response is received via the alpha- and betareceptors are related to the hemodynamic of the vasculature of the lungs and cardiovascular system. The beta-blockade agents are one of the most common medication classes used for rate control in cardiac arrhythmias, but the side effect could be COPD exacerbation; on the other hand, beta-adrenergic or beta-agonist as a therapy for this pulmonary condition could increase the heart rate leading to AF decompensation. There is a clear dilemma in our patients who have airway disease and AF since the treatment for one might worsen the other. The clear benefit in morbidity and mortality of beta-blocker therapy, especially beta1- selective, outweighs the potential for any pulmonary side-effects related to ex-acerbation of COPD or airway disease. Conclusion: There is clear data showing the evidence of the potential paradoxical side-effect between COPD and AF therapies, given the exacerbation of one due to treatment of the other, benefits versus risks should be discussed and the medical decision should be made based on them. The deteriorated cardiac condition can rapidly predispose to critical complications leading to death, which is why the use of beta-blockade agents will be chosen over possible complications with pulmonary disease. In other words, the benefit should outweigh the risk based on the best outcome for the patient.

Socio-demographic and clinical patterns of patients with obstructive airway disease

Background: Obstructive airway disease (OAD) includes two entities that share many common characteristics. Those are asthma and chronic obstructive pulmonary disease (COPD). On the other hand, in our regular practice, we observe that psychiatric symptoms of anxiety, depression, and cognitive dysfunction often occur in patients suffering from such diseases which are also associated with their socio-demographic and clinical status. Aim of the study: The aim of this study was to determine the socio-demographic and clinical status of patients with OAD.Methods: This was a cross-sectional observational study which was conducted at the department of respiratory medicine in the national institute of diseases of the chest and hospital, Dhaka, Bangladesh during the period from March 2018 to February 2019 in collaboration with the department of pathology, radiology, and respiratory laboratory. A total of 160 cases of asthma or COPD were enrolled in this study. Statistical analyses of the results were obtained by using Windows-based computer software devised with statistical packages for social sciences (SPSS-23.0).Results: A total number of 160 patients were selected and the mean age of the total participants was 53.0±14.0 years. In this study, the male-female ratio of the study people was 1.13:1. The majority (91.2%) of patients were married. Almost three fourth (73.7%) of patients were from rural areas. Almost one-third (31.9%) of patients completed primary education level. The majority (27.5%) of the patients were service holders. The average monthly income was 1871.9±4888.8 taka. Almost two-thirds (66.3%) of patients were smokers. In total 98 (61.3%) patients had COPD and 62 (38.7%) had asthma. In this study in total 98 (61.3%) patients had COPD and 62 (38.7%) had asthma. Among 98 COPD patients 10 (10.2%) had mild, 29 (29.6%) had moderate, 40 (40.8%) had severe and 19 (19.4%) had very severe COPD. Among 62 asthmatic patients 22 (35.5%) had mild, 16 (25.8%) had moderate, 11 (17.7%) had severe and 13 (21.0%) had very severe asthma.Conclusions: According to the findings of this study we can conclude that the frequency of OAD is higher among aged, smokers, married male people than others. The ratio of COPD patients may be higher than asthmatic patients among the rural population of Bangladesh. The mean depression inventory score was found to some higher among asthmatic patients than that of COPD patients.