Monday, 6 December 2010
The course and the prognosis of the bronchial asthma (BA) depend not only on the correct antiasthmatic treatment, but on the comorbid conditions. Cardiovascular diseases have a great impact and may complicate the treatment of the patients with BA. The influence of the cardiovascular pathology on the course of BA can be caused both with the illness itself and applied medications. Antihypertensive treatment sometimes is associated with direct negative influence on the bronchial resistance, sputum production, bronchial hyperreactivity and the quality of life. The purpose: to estimate the effectiveness and safety of angiotensin-converting enzyme inhibitors (ACEi) and their combination with calcium antagonists (CA) in patients with BA. Methods: 60 patients with a controlled BA and not controlled arterial hypertension (AH) were selected. All patients underwent a complex examination, including spirography and bodypletismography, arterial blood pressure (BP) monitoring, echocardiography and quality of life (QL) questionnaires. Afterwards they were randomized into 2 groups of similar age and gender. 1st group was treated with ACEi (enalapril 2.5-20mg) and the 2nd received the combination of ACEi and CA in a fixed combination (verapamil + trandolapril 180/2). After 6 month of treatment the complex examination was repeated. Results: 3 (5%) patients were excluded because of cough after the beginning of ACEi treatment. The normal levels of BP were achieved in 100%. The antihypertensive treatment did not lead to the BA exacerbations (the reasons of the exacerbations were viral and bacterial infections of the respiratory tract). The treatment with enalapril decreased the hypertrophy of the left ventricle (p<0.01) (was not observed in the 2nd group), while the fixed combination improved the systolic function of the right ventricle (was not observed in the 1st group).No negative influence of ACEi on the parameters of lung functions were observed, the combined treatment improved the diffusion capacity (p<0.03). The QL improved statistically significant in the both groups. Conclusion: ACEi and CA are effective and safe in patients with AH and BA. ACEi and CA have no negative impact on the course of BA and lung function parameters, the combination of ACEi with CA improves the diffusion capacity. Patients with BA are not in a higher risk of the cough (comparing with the whole population) while treated with ACEi. Only the adequate treatment of both conditions may lead to a better prognosis and improve QL.