Answer: E. Both C and D are correct

Discussion


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Heart disease is the leading cause of death in patients with COPD when respiratory failure is excluded. 1 In fact, patients with COPD are at increased risk for atherosclerotic events independent of their age, gender, or smoking history. 1 In patients with COPD, the use of long acting beta-agonists has not been shown to increase the risk for MI.2,3 Furthermore, inhaled glucocorticoids have been shown to be safe in patients who are otherwise at increased risk for cardiovascular disease.4 Thus, options A and B are incorrect.

COPD itself is associated with increased systemic inflammation, which contributes to the pathogenesis of coronary atherosclerosis. 1 Recent studies have shown that platelet reactivity is increased during acute exacerbations of COPD, even if patients are taking antiplatelet agents.1 Thus, the best answer is option E.

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References

  1. Muñoz-Esquerre M, Ferreiro JL, Huertas D, et al. Impact of acute exacerbations on platelet reactivity in chronic obstructive pulmonary disease patients. Int J Chron Obstruct Pulmon Dis. 2018;13:141-148.
  2. Ferguson GT, Funck-Brentano C, Fischer T, Darken P, Reisner C. Cardiovascular safety of salmeterol in COPD. Chest. 2003;123(6):1817-1824.
  3. Tranfa CM, Pelaia G, Grembiale RD, Naty S, Durante S, Borrello G. Short-term cardiovascular effects of salmeterol. Chest. 1998;113(5):1272-1276.
  4. Calverley PM, Anderson JA, Celli B, et al; for the TORCH Investigators. Cardiovascular events in patients with COPD: TORCH study results. Thorax. 2010;65(8):719-725.