Oral terbutaline augments cardiac performance in chronic obstructive pulmonary disease

In previous research, we have demonstrated that parenterally administered terbutaline can augment resting cardiac function in patients with chronic obstructive pulmonary disease (COPD). Because the oral form of terbutaline is more widely utilized, a double-blind, randomized, crossover, placebo-controlled trial of the cardiopulmonary effects of oral terbutaline was conducted in ten patients with COPD. Right and left ventricular ejection fractions (RVEF and LVEF) were determined by first pass radionuclide angiography. There were no differences in spirometry and hemodynamic measurements between treatment and placebo days. Following 5 mg of oral terbutaline, there was a small but statistically significant increase in forced expiratory volume in 1 second and in heart rate, but no significant change in forced vital capacity or blood pressure. LVEF improved significantly with terbutaline both at rest (62% +/- 6% vs. 67% +/- 9%, mean +/- SD) and during submaximal steady state exercise (61% +/- 5% vs. 67% +/- 10%). RVEF improved significantly at rest (64% +/- 6% vs. 69% +/- 5%), but not during submaximal steady state exercise (65% +/- 6% vs. 68% +/- 7%). Thus, oral terbutaline produces significant improvement in biventricular systolic pump performance at rest, and increases left ventricular ejection fraction during submaximal exercise in patients with moderate to severe COPD.