Martínez, Marina González

Asthma, chronic obstructive pulmonary disease, and other respiratory disorders often occur concurrently with heart failure (HF). HF patients with respiratory disease can improve lung function and, therefore, quality of life with β‐agonists. Beta‐agonist use remains controversial as it has been linked with increased mortality risk; however, recent studies that account for co‐morbidities find no association between β‐agonist use and mortality. Previous studies exploring the cardiovascular effect of β‐agonist use in HF are primarily retrospective and focus on heart rate (HR). We have previously demonstrated altered cardiovascular function in response to albuterol in healthy subjects. In the present study we sought to comprehensively assess the cardiovascular effects of albuterol sulfate using cardiac output (Q), stroke volume (SV), HR, systolic, diastolic, and mean arterial blood pressure (SBP, DBP, MAP, respectively) and systemic vascular resistance (SVR). We hypothesized that cardiovascular parameters would be altered 30‐minutes following albuterol administration, and that HF patients using β‐blockers would have an attenuated response. Twenty‐two healthy and twenty‐two HF subjects were recruited (age=56±13 vs. 62±12yrs; height=175±10 vs. 176±9cm; weight=78±15 vs. 93±20; BMI=26±4 vs. 30±6; and BSA=2.08±0 vs. 1.93±0m 2 , for healthy and HF, respectively, p<0.05 for weight, BMI, and BSA). We found that HR and Q increased in healthy but not HF subjects at 30min following albuterol. Patients who were not on β‐blockers (n=4, 18%) had an increase in SV and a decrease in SVR with albuterol, while there was no change in patients who were on β‐blockers (n=14, 64%). These data suggest that HF patients have an attenuated cardiovascular response to inhaled albuterol, particularly with concurrent β‐blocker usage.

Background: The Vibralung Acoustical Percussor is a new airway clearance therapy (ACT) utilizing intrapulmonary sound waves in addition to positive expiratory pressure (PEP). We evaluated the safety of the Vibralung and collected preliminary data on its ability to mediate sputum expectoration in individuals with cystic fibrosis (CF). Methods: Over two separate studies, 10 and 11 mild to moderate CF patients were recruited for study I and II, respectively. Study I: Vibralung was used for 20 min with either no sound (NS: PEP only) or sound (S: PEP and sound) on randomized visits. Pulmonary function, diffusion capacity of the lungs for carbon monoxide and nitric oxide (DLCO/DLNO), symptoms, and peripheral oxygen saturation (SpO2) were measured at baseline and at 1 and 4 h post treatment. Expectorated sputum was collected over 4 h post treatment. Study II: over 5 days of in-hospital therapy, the Vibralung or vibratory vest therapy (Vest) were used for two therapy sessions per day, with sputum collected for 20 min following each therapy and pulmonary function accessed pre and post each 5-day period (days 1–5 or 7–11) in a randomized crossover design. Results: Vibralung usage resulted in no change from baseline to 4 h post in pulmonary function, SpO2 or symptoms ( p > 0.05). At 4 h post therapy, the DLCO- and DLNO-derived measure of alveolar–capillary unit function (DM/ VC) showed improvement (DM/ VC = 12.5 ± 5.5 versus 7.3 ± 18.8% change, S versus NS) with no difference between S and NS ( p = 0.74). Sputum expectoration was similar between S and NS conditions (wet sputum = 10.5 ± 4.6 versus 9.9 ± 3.2 g, S versus NS, p = 0.25). There were no differences in the improvement in pulmonary function between Vibralung and Vest during either 5-day period during the hospital stay. Conclusions: Vibralung was well tolerated and caused no detrimental changes in pulmonary function metrics. The Vibralung appears to be a safe ACT in individuals with CF.