Regadenoson use in patients with chronic obstructive pulmonary disease: the state of current knowledge

Abstract

Stress testing is challenging in patients with chronic obstructive pulmonary disease (COPD). Functional capacity is generally decreased in this patient population, limiting patients' ability to achieve physiologic stress through exercise. Additionally, due to emphysematous changes, COPD patients tend to have poor acoustic windows that impair the quality and therefore diagnostic accuracy of stress echocardiography techniques. Pharmacologic stress myocardial perfusion imaging (MPI) testing is also problematic, particularly due to the concern for adenosine-induced bronchoconstriction with conventional vasodilator stress agents. Regadenoson, a selective A2A adenosine receptor agonist, has gained popularity due to its ease of administration and improved patient experience in the general population. The literature describing the experience with regadenoson in COPD patients, though limited, is rapidly growing and reassuring. This review summarizes the pharmacology and clinical application of this novel stress agent and presents the available data on the safety and tolerability of its use in COPD patients.

Keywords: COPD; asthma; chronic obstructive pulmonary disease; emphysema; myocardial perfusion imaging; regadenoson; safety; tolerability.

Figure 1

Adenosine receptor subtypes, mechanisms of action, and clinical effects. Note: Springer and J Nucl Cardiol, 17, 2010, 494–497, The emerging role of the selective A2A agonist in pharmacologic stress testing, Gemignani AS, Abbott BG, Figure 1. With kind permission from Springer Science and Business Media. Abbreviations: ATP, adenosine triphosphate; cAMP, cyclic adenosine monophosphate.

Figure 2

Regadenoson molecule. Note: Reproduced with permission from Astellas Pharma; US Lexiscan Product Monograph. 2012.

Figure 3

Mean FEV₁ and mean FVC changes following regadenoson. Notes: For comparison of regadenoson and placebo for all time points, data are expressed as least squares mean ± standard error (P≥0.074 and P>0.28, respectively). The regadenoson curve is staggered slightly to the right to improve visualization of both sets of error bars. Springer and J Nucl Cardiol, 15, 2008, 319–328, Safety of regadenoson, a selective adenosine A2A agonist, in patients with chronic obstructive pulmonary disease: a randomized, double-blind, placebo-controlled trial (RegCOPD trial), Thomas GS, Tammelin BR, Schiffman GL, et al, Figures 2 and 3. With kind permission from Springer Science and Business Media. Abbreviations: FEV₁, forced expiratory volume in 1 second; FVC, forced vital capacity.