Principles of treatment of unstable angina in patients with chronic obstructive pulmonary disease

Abstract

Background. Unstable angina (UA), a type of acute coronary syndrome (ACS), needs prompt care in patients with chronic obstructive pulmonary disease (COPD) due to high complication risk. Coronary involvement is seen in 30–40% of cases, with 30-day mortality reaching up to 30%, exceeding that of the general population. Objective(s). The aim was to evaluate the treatment of UA in COPD patients, identifying indicated and contraindicated drugs, to improve prognosis and specific clinical management. Materials and methods. This study is based on the analysis of scientific articles published between 2020 and 2025, available in the PubMed database, clinical guidelines of the European Society of Cardiology (ESC), and national clinical protocols (PCN-18, PCN-81), offering a current and relevant foundation for the treatment of UA in COPD patients. Results. The therapeutic drug classes used include selective beta-blockers (e.g., metoprolol) preferred to avoid bronchospasm, and calcium channel blockers (e.g., amlodipine) which promote coronary vasodilation. Nitrates (e.g., nitroglycerin) are administered early, at the onset of chest pain, transitioning to intravenous form if symptoms persist. Oxygen therapy is indicated to correct hypoxemia. Heparin is used in the acute phase, aspirin is recommended for long-term thrombosis prevention, and clopidogrel may be added after revascularization. Revascularization should not be delayed but should be tailored to COPD severity. Conclusion(s). The treatment of UA in COPD patients follows the general principles of ACS management, emphasizing the use of selective beta-blockers, nitrates, calcium channel blockers, antiplatelet agents, oxygen therapy, optimization of COPD therapy, and control of risk factors (dyslipidemia, smoking, etc.).