Cardiopulmonary Effects of Combined β1-Selective Blockers, Ivabradine, and β2-Agonists in Ischemic Heart Disease with Chronic Obstructive Pulmonary Disease

Background: The coexistence of ischemic heart disease (IHD) and chronic obstructive pulmonary disease (COPD) presents significant therapeutic challenges due to potential pharmacological interactions between β-blockers and β2-agonists. Traditionally, the combined long-term use of these agents has been approached with caution. However, recent evidence suggests that cardioselective β1-blockers may be safely administered in such comorbid conditions.Objective: To evaluate the safety and clinical efficacy of a balanced combined therapy consisting of cardioselective β1-blockers (bisoprolol), ivabradine, and highly β2-selective agonists (salbutamol) in patients with comorbid IHD and COPD.Methods: A total of 33 patients aged 36–74 years with confirmed diagnoses of IHD and COAD were enrolled. All patients underwent comprehensive clinical, instrumental, and laboratory assessments before and after treatment. Echocardiographic parameters, electrocardiography (ECG), 24-hour ECG monitoring, pulse oximetry, blood gas analysis, and laboratory markers were evaluated. Drug dosages were carefully titrated.Results: The combined therapy resulted in improvement of both left and right ventricular functional parameters, pulmonary hemodynamics, and overall clinical status, without clinically significant adverse effects.Conclusion: The combined use of cardioselective β1-blockers, ivabradine, and β2-agonists appears to be safe and effective in patients with comorbid IHD and COPD when doses are carefully titrated and gradually withdrawn.