COPD Therapy Improves Cardiac Function: ERS 2026

Dual bronchodilation with umeclidinium/vilanterol significantly improved cardiac function during exercise in patients with chronic obstructive pulmonary disease (COPD), lung hyperinflation, and impaired left ventricular function, according to late-breaking research presented at the European Respiratory Society (ERS) Congress.

The Phase IV, double-blind, randomised, placebo-controlled crossover trial provides new evidence on the cardiopulmonary effects of long-acting dual bronchodilation in a population in whom COPD and cardiac dysfunction coexist.

Lung hyperinflation is common in COPD and can adversely affect cardiac function. Although previous research has indicated that long-acting dual bronchodilation may improve left ventricular filling, its effects had not previously been evaluated in patients with concomitant impairment of left ventricular function.

Testing Dual Bronchodilation in Cardiac Dysfunction

The single-centre study enrolled patients with a COPD diagnosis according to Global Initiative for Chronic Obstructive Lung Disease criteria, alongside evidence of lung hyperinflation and impaired cardiac function. Eligibility required a residual volume (RV) >125%, an RV/total lung capacity ratio >35%, and a resting left ventricular ejection fraction (LVEF) <50%.

Following a 2-week washout period, participants were randomly assigned to once-daily inhaled umeclidinium/vilanterol 55/22 μg or placebo delivered through an Ellipta device. Each treatment period lasted 14 days, with a further 14-day washout separating the two crossover periods.

A total of 63 patients were enrolled, with 54 available for analysis. Mean age was 61 years, mean post-bronchodilator FEV1 was 66% predicted, and mean RV was 166% predicted, demonstrating substantial hyperinflation. Mean resting LVEF was 46%, while peak oxygen consumption was 15 mL/min/kg.

Cardiac Function Improves During Exercise

The primary outcome was the ratio of maximal exercise to baseline velocity time integral (VTI), assessed by echocardiography at the aortic valve. VTI reflects the distance travelled by blood during each heartbeat and provides an indicator of cardiac output-related function.

The maximal exercise-to-baseline VTI ratio reached 1.51 with umeclidinium/vilanterol compared with 1.21 with placebo, corresponding to a mean difference of 0.30 (p<0.001).

The investigators also reported significant improvements in lung hyperinflation and dyspnoea, alongside meaningful improvements in exercise parameters during treatment with umeclidinium/vilanterol.

Linking Lung and Heart Function in COPD

The findings suggest that reducing lung hyperinflation through dual bronchodilation may have benefits extending beyond respiratory symptoms in patients with COPD and coexisting left ventricular dysfunction.

This may be particularly relevant given the frequent coexistence of pulmonary and cardiovascular disease in COPD and the potential for hyperinflated lungs to adversely influence cardiac performance.

The investigators concluded that umeclidinium/vilanterol significantly improved cardiac function during exercise in patients with COPD and left ventricular dysfunction. The results also highlight the importance of considering the interaction between pulmonary mechanics, exercise capacity, and cardiovascular function when managing patients with COPD and concomitant heart failure.

Reference

Meastu PL et al. Late Breaking Abstract – Phase IV, single-center, double-blind, randomized, placebo-controlled, crossover clinical trial designed to evaluate the effect of double
bronchodilation with umeclidinium/vilanterol in patients with COPD, hyperinflation, and heart failure. Abstract 394. ERS Congress, 6-9 September 2026.