Practical recommendations for the use of beta-blockers in chronic obstructive pulmonary disease

Expert Rev Respir Med. 2020 Jul;14(7):671-678. doi: 10.1080/17476348.2020.1752671. Epub 2020 Apr 19.

Abstract

Introduction: Controversies regarding the use of beta-blocker in chronic obstructive pulmonary disease (COPD) have been longstanding and based on inconsistent data. COPD and cardiovascular disease have many shared risk factors and potentially overlapping pathophysiologic mechanisms. Beta-blockers, a mainstay of treatment in ischemic heart disease, congestive heart failure, and cardiac arrhythmia, remain underutilized in COPD patients despite considerable evidence of safety. Furthermore, observational studies indicated the potential benefits of beta-blockers in COPD via a variety of possible mechanisms. Recently, a randomized controlled trial of metoprolol versus placebo failed to show a reduction in COPD exacerbation risk in subjects with moderate to severe COPD and no absolute indication for beta-blocker use.

Areas covered: Physiology of beta-adrenergic receptors, links between COPD and cardiovascular disease, and the role of beta-blockers in COPD management are discussed.

Expert commentary: Beta-blockers should not be used to treat COPD patients who do not have conditions with clear guideline-directed recommendations for their use. Vigilance is recommended in prescribing these medications for indications where another drug class could be utilized.

Keywords: Beta-blocker; COPD; arrhythmia; congestive heart failure; ischemic heart disease.

Publication types

  • Review

MeSH terms

  • Adrenergic beta-Antagonists / therapeutic use
  • Arrhythmias, Cardiac / drug therapy
  • Heart Failure / drug therapy
  • Humans
  • Metoprolol / therapeutic use*
  • Myocardial Ischemia / drug therapy
  • Practice Guidelines as Topic
  • Pulmonary Disease, Chronic Obstructive / drug therapy*
  • Risk Factors

Substances

  • Adrenergic beta-Antagonists
  • Metoprolol