digoxin and Lung-Diseases--Obstructive

Topics: Animals; Digoxin; Dopamine; Humans; Lung Diseases, Obstructive; Respiratory Insufficiency; Respiratory Muscles; Theophylline

Outpatient management of chronic obstructive pulmonary disease (COPD) is reviewed in this paper. Smoking cessation is probably important, although its benefit in established COPD is unproven. Bronchodilator therapy may be of more than symptomatic benefit and is indicated in virtually all patients. Specific beta 2-agonists are the most widely used agents and can be given in substantially larger doses than are usually recommended. Ipratropium bromide, an anticholinergic drug, is about as effective as a beta 2-agonist, but in large doses the two drugs do not seem to have additive effects, unlike theophylline and beta 2-agonists. Systemic corticosteroids decrease airway obstruction substantially in a small number of patients with COPD; these agents should be reserved for these patients and used sparingly. Inhaled steroids are of little benefit, as are respiratory stimulants and depressants. Broad-spectrum antibiotic therapy helps to relieve symptomatic exacerbations of COPD, particularly those characterized by increased dyspnea, sputum volume and sputum purulence. Cor pulmonale is best managed by diuretics and oxygen, with digoxin reserved for left ventricular failure and supraventricular arrhythmias. Continuous oxygen therapy at home is indicated for the patients who have chronic arterial hypoxemia.

Topics: Adrenal Cortex Hormones; Aged; Ambulatory Care; Anti-Bacterial Agents; Bronchodilator Agents; Digoxin; Diuretics; Humans; Influenza Vaccines; Lung Diseases, Obstructive; Oxygen Inhalation Therapy; Smoking

Topics: Adolescent; Adult; Age Factors; Aged; Animals; Child; Child, Preschool; Coronary Disease; Digitalis Glycosides; Digoxin; Dogs; Drug Administration Schedule; Drug Interactions; Female; Humans; Infant; Infant, Newborn; Kinetics; Lung Diseases, Obstructive; Male; Middle Aged; Pregnancy

Topics: Action Potentials; Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Bradycardia; Digitalis Glycosides; Digoxin; Fever; Heart Atria; Heart Block; Humans; Hypotension; Lung Diseases, Obstructive; Methoxamine; Pacemaker, Artificial; Procainamide; Propranolol; Pulmonary Embolism; Quinidine; Tachycardia; Tachycardia, Paroxysmal; Ventricular Fibrillation

Recently it has been recognized that steady-state serum digoxin concentrations may increase or fall to ineffective levels when the glycoside is administered together with several antibiotics. Our study was designed to assess if serum digoxin levels may be modified by the concomitant use of a ticarcillin and clavulanic acid. The study was carried out in 15 hospitalized patients suffering from exacerbation of their chronic bronchitis without liver disease and renal failure. Serum digoxin levels were not significantly modified by the concomitant use of a ticarcillin and clavulanic acid, although peak digoxin serum concentrations were slightly lower. However, the average time to achieve the maximum concentration and area under the curve over 24 h did not change.

Topics: Aged; Bronchitis; Chronic Disease; Clavulanic Acids; Digoxin; Drug Interactions; Drug Therapy, Combination; Female; Humans; Lung Diseases, Obstructive; Male; Middle Aged; Ticarcillin

The effect of 2 weeks oral digoxin administration on respiratory muscle performance (RMP) in 14 patients with chronic obstructive lung disease (COPD) was investigated in a randomized double-blind placebo-controlled cross-over study. All patients were ambulatory with severe air flow obstruction. FEV1/FVC was 0.44 +/- (SD) 0.11, FEV1 was 0.88 +/- (SD) 0.35 liter/s RMP was assessed by measuring maximal inspiratory pressure (PImax), maximal expiratory pressure (PEmax), and maximal voluntary ventilation. Although these parameters were significantly reduced in the COPD patients, 2 weeks of digoxin administration (with serum levels in the therapeutic range) did not alter any parameter of RMP or spirometry. We conclude that digoxin has no effect on RMP or spirometry in ambulatory patients with severe COPD.

Topics: Adult; Aged; Digoxin; Double-Blind Method; Humans; Lung Diseases, Obstructive; Male; Middle Aged; Respiratory Mechanics; Respiratory Muscles

We have studied the effect of long-term digoxin on exercise performance in 15 patients with pulmonary heart disease due to severe chronic airflow obstruction (FEV1/VC ratio 29 +/- 6%: mean +/- SD). Digoxin (0.25 mg/day) was given for 8 weeks in a randomized, double-blind crossover, placebo-controlled trial. All patients were ambulatory and had clinical features of right ventricular dysfunction but no clinical evidence of left ventricular dysfunction. Assessments included progressive and steady-state exercise, pulmonary function studies and evaluation of right and left ventricular function. In all patients the right ventricular ejection fraction was reduced; in 4 patients the left ventricular ejection fraction was also reduced. In patients whose left ventricular ejection fraction was initially abnormal, 8 weeks of digoxin increased left ventricular ejection fraction to normal. In spite of the improvement in resting ventricular function, exercise performance, the cardiopulmonary response to exercise, pulmonary function and general health status did not improve. We conclude that in patients with pulmonary heart disease: 1) digoxin improves ventricular function only if left ventricular function is reduced, and 2) despite the improvement in ventricular function digoxin does not improve pulmonary function, cardiopulmonary response to exercise or general feeling of well being.

Topics: Aged; Digoxin; Double-Blind Method; Drug Evaluation; Exercise Test; Female; Heart Rate; Humans; Lung Diseases, Obstructive; Male; Middle Aged; Pulmonary Heart Disease; Random Allocation; Respiration; Respiratory Function Tests; Stroke Volume

We evaluated 12 patients with stable chronic airflow obstruction (CAO) and no clinical evidence of left ventricular disease to determine the effects of oral digoxin on exercise capacity (VO2 max) and on right ventricular pump function during exercise. In this randomized, double blind, placebo controlled, cross-over study, patients performed exercise tests and underwent measurement of ejection fractions after two weeks of therapy with oral digoxin (0.25 mg/day) and after two weeks of placebo. Incremental upright exercise testing to a symptom-limited maximum was performed on a cycle ergometer. Right and left ventricular ejection fractions (RVEF, LVEF) were obtained in the supine position at rest and at approximately 75 percent of the maximum workload by gated equilibrium radionuclide angiography. All patients had abnormal right ventricular function, manifested either by a low resting RVEF (less than 45 percent) or a subnormal response to exercise (less than 5 percent increase). The small increases in RVEF with digoxin (mean +/- SE) at rest (44 +/- 5 vs 41 +/- 4 percent) and during exercise (46 +/- 4 vs 44 +/- 3 percent) did not achieve statistical significance. With digoxin, small increases in exercise duration (10.0 +/- 1.5 vs 9.0 +/- 1.4 min), maximum workload achieved (48 +/- 6 vs 42 +/- 5 W), VO2 max (0.85 +/- 0.06 vs 0.81 +/- 0.06 L/min), and oxygen-pulse (O2-P) (6.6 +/- 0.5 vs 6.3 +/- 0.4 ml/beat) occurred. Only the increase in O2-P was significant (p less than 0.05). From this study we conclude that digoxin does not significantly improve exercise capacity in severe chronic airflow obstruction with impaired right ventricular function, nor does it improve RVEF either at rest or during supine submaximal exercise.

Topics: Digoxin; Exercise Test; Heart; Heart Ventricles; Humans; Lung Diseases, Obstructive; Middle Aged; Physical Exertion; Radionuclide Imaging; Respiratory Function Tests; Sodium Pertechnetate Tc 99m; Stroke Volume; Technetium

The effect of digoxin on the right and left ventricular ejection fractions in 15 patients with pulmonary heart disease caused by severe chronic airflow obstruction was studied in a double-blind, randomized, placebo-controlled trial. All patients were ambulatory and had clinical features of right but not left ventricular dysfunction. Equilibrium radionuclide angiography showed reduced right ventricular ejection fraction in all patients and reduced left ventricular ejection fraction in four. After 8 weeks of digoxin treatment, the abnormal left ventricular ejection fractions were normal; right ventricular ejection fractions increased only in those patients who had had abnormal left ventricular ejection fractions. We conclude that in patients with pulmonary heart disease, the right ventricular ejection fraction is abnormal and improves with digoxin treatment only when the left ventricular ejection fraction also is initially abnormal.

Topics: Aged; Cardiac Output; Clinical Trials as Topic; Digoxin; Double-Blind Method; Female; Humans; Lung Diseases, Obstructive; Male; Middle Aged; Pulmonary Heart Disease; Random Allocation; Stroke Volume

Rate-control medications are considered first-line treatment for patients with atrial fibrillation (AF). However, obstructive lung disease (OLD), a condition prevalent in those with AF, often makes it difficult to use those medications because of the lack of studies on new-onset AF in patients with OLD.. The purpose of this study was to investigate clinical outcomes after administration of each class of rate-control medication in patients with concomitant AF and OLD (AF-OLD).. This study used the entire database provided by the National Health Insurance Service from 2002 to 2015. Risk of all-cause mortality was compared between use of calcium channel blocker (CCB) and use of other drug classes in AF-OLD patients using Cox regression analyses after propensity score matching.. Among the 13,111 patients, the number of AF-OLD patients treated with a CCB, cardioselective β-blocker (BB), nonselective BB, and digoxin was 2482, 2379, 2255, and 5995, respectively. The risk of mortality was lower with use of selective BB (hazard ratio [HR] 0.84; 95% confidence interval [CI] 0.75-0.94; P = .002) and nonselective BB (HR 0.85; 95% CI 0.77-0.95; P = .003) compared to use of CCBs. Digoxin use was related with worse survival, with marginal statistical significance (HR 1.09; 95% CI 1.00-1.18; P = .053).. Among patients with AF-OLD, rate-control treatment using selective and nonselective BB was associated with a significant reduction in mortality compared with CCB use. Further prospective randomized trials are required to confirm these findings.

Topics: Adrenergic beta-Antagonists; Aged; Anti-Arrhythmia Agents; Atrial Fibrillation; Cause of Death; Digoxin; Female; Heart Rate; Humans; Lung Diseases, Obstructive; Male; Propensity Score; Republic of Korea; Retrospective Studies; Survival Rate

The choice of administering digitalis to older patients with congestive heart failure (CHF) cannot be made on the account of univocally defined criteria because of uncertainty about efficacy and concern about safety of digitalis in this population. The purpose of this study was to verify whether the clinical characteristics on admission to the acute care hospital determine the use of digitalis therapy in elderly patients.. A total of 1239 patients (mean age 77.8 +/- 7.1 years, range 65-100 years, males 49.8%) consecutively admitted to 69 General Medicine and Geriatrics wards over a 4-month period were grouped by combining two dichotomous factors (Carlson's score > 4: definite or possible diagnosis of CHF; Carlson's score < 5: unlikely diagnosis of CHF; in-hospital adoption of digitalis therapy: yes or no) as follows: Group A: Carlson's score > 4, digitalis (n = 413); Group B: Carlson's score > 4, no digitalis (n = 260); Group C: Carlson's score < 5, digitalis (n = 104); Group D: Carlson's score < 5, no digitalis (n = 462). Variables significantly distinguishing groups were entered into a discriminant analysis aimed at assessing the group specificity of individual clinical profiles.. Use of digoxin at home, atrial fibrillation, older age, and comorbidity (mainly COPD and chronic renal failure) characterized most of the patients given digoxin with or without a definite diagnosis of CHF. Clinical profiles of groups A, B, and C largely overlapped.. Age, historical use of digitalis, and comorbidity might lead to seemingly incongruous digitalis prescription. The choice of adopting digitalis therapy cannot be reliably predicted on the basis of clinical variables only. Presently unexplored physician-related factors, such as cultural background, likely outweigh clinical variables in prompting digitalis prescription.

Topics: Aged; Aged, 80 and over; Atrial Fibrillation; Cardiotonic Agents; Digoxin; Discriminant Analysis; Female; Heart Failure; Hospitals; Humans; Lung Diseases, Obstructive; Male; Medical Records

1. Recently, we have demonstrated that hypoxic breathing is followed by an increase in plasma digoxin-like substance in normal men. 2. This study was undertaken in order to evaluate whether or not a low arterial O2 partial pressure is combined with an increase in plasma digoxin-like substance in chronic pathological conditions also. 3. Sixteen male patients (mean age 53.1 +/- 3.7 years) affected by chronic obstructive pulmonary disease of a mild stage were studied. They were further subdivided according to their arterial O2 partial pressure into 'mild hypoxic' (n = 8, mean age 52.5 +/- 2.7 years), with an arterial O2 partial pressure between 66 and 75 mmHg, and 'severe hypoxic' (n = 8, mean age 54.3 +/- 5.1 years), with an arterial O2 partial pressure < or = 65 mmHg, groups. Seven healthy men (mean age 48.5 +/- 4.8 years) voluntarily participated as the control group. 4. Plasma digoxin-like substance levels were significantly higher in 'severe hypoxic' patients (203.5 +/- 9.9 pg/ml) than in both 'mild hypoxic' patients (169.5 +/- 31.4 pg/ml, P < 0.02) and normal subjects (158.9 +/- 12.4 pg/ml, P < 0.0001) and were directly correlated with urinary Na+ excretion (severe hypoxic group, r = 0.756, P < 0.007; mild hypoxic group, r = 0.789, P < 0.02). Considering the two hypoxic groups together, plasma digoxin-like substance levels were negatively correlated with arterial O2 partial pressure (r = -0.740, P < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Aged; Blood Proteins; Cardenolides; Digoxin; Humans; Hypoxia; Lung Diseases, Obstructive; Male; Middle Aged; Oxygen; Partial Pressure; Saponins; Sodium; Sodium-Potassium-Exchanging ATPase

Despite the absence of cardiac or renal pathologies, edema and mild hyponatremia may often occur in patients affected by chronic obstructive pulmonary disease (COPD). Therefore, it has been suggested that hypoxia may influence the release of different hormones regulating renal sodium handling. To evaluate the effect of hyperoxia and O2 removal on plasma digitalis-like substance (DLS) levels, 9 patients affected by COPD and 7 normal subjects were studied. After 1 h in supine position, O2 was administered for 3 h by a tight-fitting face-mask. Blood samples for plasma DLS were taken at time 0, 60, 180 min and then for 3 h after O2 removal. In normal subjects, plasma DLS did not vary after O2 administration (from basal values of 162.25 +/- 8.59 to 107.75 +/- 6.65 pg/ml at 180 min; NS), and O2 removal (143.7 +/- 16.87 pg/ml after 3 h from O2 removal; NS). On the contrary, in patients affected by COPD, plasma DLS levels increased during O2 administration (from basal values of 138.98 +/- 8.31 to 202.14 +/- 8.21 pg/ml at 180 min; p < 0.05), and returned to baseline levels (142.59 +/- 8.28 pg/ml) 3 h after O2 removal. In the same patients, DLS increase was accompanied by a rise in Na+ excretion (from 0.08 +/- 0.01 at time 0 to 0.16 +/- 0.02 mEq/min after 3 h of O2 administration; p < 0.05). In conclusion, our findings showed an oxygen-related increase in plasma DLS levels and in urinary Na+ excretion in patients affected by COPD. This phenomenon could promote Na+ urinary loss during prolonged O2 therapy in these patients and should be taken into account in their management.

Topics: Blood Proteins; Carbon Dioxide; Cardenolides; Digoxin; Humans; Hypoxia; Kidney; Lung Diseases, Obstructive; Male; Middle Aged; Oxygen; Oxygen Inhalation Therapy; Saponins; Sodium; Sodium-Potassium-Exchanging ATPase

Topics: Aged; Aging; Captopril; Digoxin; Furosemide; Heart Failure; Humans; Hypertension; Kidney Diseases; Lung Diseases, Obstructive; Male

Gastrointestinal and cardiac manifestations are the commonly considered features of digoxin toxicity. This report describes a patient with severe chronic obstructive lung disease whose primary manifestation of digoxin toxicity is acute alteration of mental status. Neurologic dysfunction may be the sole manifestation of digitalis toxicity. The diagnosis of digoxin toxicity should be considered in elderly patients with altered mental status, even when serum levels are within a therapeutic range.

Topics: Aged; Digoxin; Electrocardiography; Humans; Lung Diseases, Obstructive; Male; Mental Disorders; Tachycardia, Paroxysmal

We studied the effects of digoxin, a compound that has an inotropic effect on the myocardium, on diaphragmatic function in 8 patients with chronic obstructive pulmonary disease. All the patients were in acute respiratory failure and were artificially ventilated. Diaphragmatic strength was assessed by measuring the transdiaphragmatic pressure generated at functional residual capacity during bilateral supramaximal electrical stimulation of the phrenic nerves. The latter were stimulated before and at 45 and 90 min after administration of digoxin (0.02 mg/kg infused for 10 min). In all the patients, cardiac output was measured by the thermodilution technique using a Swan-Ganz catheter placed in the pulmonary artery. Arterial blood gases and pH were maintained within normal range by mechanical ventilation. In all the patients, digoxin plasma levels reached the therapeutic range (mean values, 2.82 +/- 0.17 and 2.90 +/- 0.20 nmol/L at 45 and 90 min, respectively) after digoxin administration. Diaphragmatic strength improves significantly after digoxin administration, the transdiaphragmatic pressure for an identical phrenic stimulation increasing by 19.5% (p less than 0.001) on the average. This increase was noted 45 and 90 min after digoxin administration. We conclude that digoxin has a potent effect on diaphragmatic strength generation that may be beneficial in patients with chronic obstructive pulmonary disease during acute respiratory failure. Furthermore, this inotropic positive effect of digoxin on the diaphragm, as previously observed for the myocardium, emphasizes the similarities between these 2 contractile tissues.

Topics: Action Potentials; Acute Disease; Aged; Diaphragm; Digoxin; Female; Hemodynamics; Humans; Lung Diseases, Obstructive; Male; Middle Aged; Pressure; Respiratory Insufficiency

Acute digoxin intoxication in children and young adults generally occurs in three distinct age groups: in infants, a pharmacokinetically disadvantaged age group, who are given an excessive dose parenterally and invariably die from the overdose; in toddlers, a pharmacokinetically favored age group, who ingest the drug accidentally and usually recover from the overdose, and in older children and young adults, who occupy an intermediate position with respect to pharmacokinetics and prognosis.

Topics: Accidents, Home; Adult; Child, Preschool; Digoxin; Female; Heart Failure; Humans; Infant; Kinetics; Lung Diseases, Obstructive; Male; Suicide, Attempted

Sixteen patients with multifocal atrial tachycardia (MAT) who were taking theophylline were identified over 6 months. After theophylline was discontinued the atrial rate fell and MAT resolved in all sixteen patients. Five patients were challenged with intravenous aminophylline to investigate the role of theophylline in the genesis of MAT. MAT with a rapid ventricular response occurred in all five even though metabolic and respiratory variables did not change. MAT returned on challenge in three patients in whom serum theophylline levels were within the generally accepted therapeutic range (10-20 mg/l). In individual patients, theophylline had a dose-related effect on the atrial rate and the amount of ectopic atrial activity. Thus, theophylline may commonly precipitate MAT and treatment with the drug should be carefully considered in patients with respiratory insufficiency and MAT.

Topics: Aged; Aminophylline; Blood Gas Analysis; Digoxin; Female; Heart Atria; Heart Rate; Humans; Lung Diseases, Obstructive; Male; Middle Aged; Potassium; Tachycardia; Theophylline

A 75-year-old woman with acute respiratory failure due to pneumonia superimposed on bronchospastic chronic obstructive pulmonary disease and dilated cardiomyopathy developed multifocal and unifocal atrial tachycardia. Arrhythmia recurrence appeared to be dependent on reaching a critical but "nontoxic" serum theophylline concentration in the presence of high normal levels of digoxin. The arrhythmias responded to a decrease in serum theophylline concentration or to the administration of verapamil. The precipitation of the atrial arrhythmias by theophylline in the presence of digitalis, both of which may increase intracellular calcium and a dramatic response to verapamil, which inhibits calcium uptake and release, suggests that these arrhythmias may represent an example of "triggered activity" in man.

Topics: Aged; Digoxin; Electrocardiography; Female; Heart Atria; Humans; Lung Diseases, Obstructive; Recurrence; Tachycardia; Theophylline; Verapamil

Topics: Aged; Cardiac Glycosides; Digoxin; Dose-Response Relationship, Drug; Drug Hypersensitivity; Electrocardiography; Female; Heart Diseases; Humans; Hypoxia; Lung Diseases, Obstructive; Male; Middle Aged

We have studied a patient with hypereosinophilic syndrome (HES) who initially presented with recurrent asthmatic attacks followed by progressive dyspnea. Chronic obstructive lung disease was suspected at first although involvement of cardiac and other organ systems and marked eosinophilia eventually led to the diagnosis. Thereafter a diffuse interstitial pattern gradually developed on the chest radiograph which persisted despite vigorous treatment for cardiac failure. This was due to infiltration and cuffing of the small pulmonary arteries by eosinophils. The bronchi showed changes consistent with asthma. Review of the literature indicates that this type of vascular change is common in HES but involves predominantly organs other than the lung. Similar pulmonary arterial changes have been produced experimentally in the calf by prolonged intravenous infusion of antibiotics, indicating that this may be a hypersensitivity reaction to a blood-borne material entering the pulmonary circulation.

Topics: Aged; Autopsy; Bronchodilator Agents; Digoxin; Eosinophilia; Female; Furosemide; Heart Failure; Humans; Intracranial Embolism and Thrombosis; Lung Diseases, Obstructive; Prednisone; Pulmonary Artery; Syndrome

Topics: Diet, Sodium-Restricted; Digoxin; Diuretics; Humans; Lung Diseases, Obstructive; Male; Middle Aged; Oxygen Inhalation Therapy; Physical Therapy Modalities; Pulmonary Heart Disease; Smoking

Topics: Aged; Coronary Disease; Digoxin; Drug Interactions; Female; Humans; Lung Diseases, Obstructive; Male; Pulmonary Heart Disease; Quinidine

The analysis of the haemodymanic responses and the behaviour of many "contractility indices" of the right ventricle -- after acute intravenous injection of large doses of acetil-digoxin, in twelve patients with CPC caused by COLD with predominant clinical signs of emphysema (group A) or bronchitis (group B) -- showed an alarming, although transient, increase of the average pulmonary pressure (PAP), accompanied by rise of pulmonary arteriolar resistanced (RAP), especially in patients of the first group. In these cases a slow and cautious digitalization is required. It furthermore suggested that such treatment should start only after an efficient restoration of ventilation, in order to allow a good response of the heart to cardiocynetic treatment.

Topics: Chronic Disease; Digoxin; Hemodynamics; Humans; Lung Diseases, Obstructive; Male; Pulmonary Heart Disease

Topics: Aged; Blood Pressure; Cardiac Output; Chronic Disease; Digoxin; Female; Heart Rate; Hemodynamics; Humans; Injections, Intravenous; Lung Diseases, Obstructive; Male; Middle Aged; Physical Exertion; Pulmonary Artery; Pulmonary Circulation; Pulmonary Heart Disease; Respiratory Function Tests; Vascular Resistance

Topics: Brain Diseases; Chemoreceptor Cells; Chronic Disease; Diagnosis, Differential; Diazepam; Digoxin; Furosemide; Humans; Hydrochlorothiazide; Hypercapnia; Hypoventilation; Hypoxia; Lung Diseases, Obstructive; Male; Obesity; Respiratory Center; Respiratory Function Tests

Topics: Aged; Aminosalicylic Acids; Arrhythmias, Cardiac; Arteriosclerosis; Cerebrovascular Disorders; Coronary Disease; Digoxin; Electrocardiography; Furosemide; Heart Conduction System; Humans; Hypertension; Isoniazid; Kidney Failure, Chronic; Lung Diseases, Obstructive; Middle Aged; Myocardial Infarction; Phenytoin