Article information
Resumen
Los broncodilatadores más efectivos en la enfermedad pulmonar obstructiva crónica (EPOC) son los β2-adrenérgicos y los anticolinérgicos. Por vía inhalatoria y a las dosis recomendadas son bien tolerados y, en general, seguros. Los β-adrenérgicos muestran efectos sistémicos de clase, como aumento de la frecuencia cardíaca, alargamiento del QT, hipopotasemia y temblor. Estos efectos tienen escasa relevancia clínica. No obstante, los pacientes con comorbilidad cardíaca o insuficiencia respiratoria pueden tener un mayor riesgo de arritmias y otros acontecimientos cardíacos adversos. No se ha demostrado que los β2-adrenérgicos de acción prolongada incrementen la mortalidad en la EPOC. Los anticolinérgicos tienen como efecto secundario más frecuente la sequedad de boca; también potencian el riesgo de glaucoma y retención urinaria. Se ha sugerido que los anticolinérgicos aumentan el riesgo cardiovascular, aunque la evidencia al respecto no es consistente. La utilización de las metilxantinas está limitada por efectos secundarios frecuentes de tipo digestivo y por su estrecho rango terapéutico.
Palabras clave:
Anticolinérgicos
β-adrenérgicos
Cardiovascular
Efectos adversos
Enfermedad pulmonar obstructiva crónica
Teofilina
Abstract
The most effective bronchodilators in chronic obstructive pulmonary disease (COPD) are β2-adrenergic and anticholinergic agents. When administered via inhalation and at recommended doses, these drugs are well tolerated and generally safe. β-Adrenergic agents show systemic effects such as an increase in heart rate, QT prolongation, hypopotassemia and tremor. These effects have little clinical significance. Nevertheless, patients with cardiac comorbidity or respiratory insufficiency can be at greater risk of arrhythmia and other adverse cardiac events. Long action β2-adrenergic agents have not been shown to increase mortality in COPD. The most frequent adverse effect of anticholinergic agents is dryness of the mouth; these drugs also increase the risk of glaucoma and urinary retention. Anticholinergic agents may increase cardiovascular risk, although the evidence is inconsistent. The use of methylxanthines is limited by frequent gastrointestinal adverse effects and by the narrow therapeutic range of these drugs.
Keywords:
Aticholinergic agents
β-adrenergic agents
Cardiovascular
Adverse effects
Chronic obstructive pulmonary disease
Theophylline
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