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Respir Med. 2014 May;108(5):737-44. doi: 10.1016/j.rmed.2014.02.009. Epub 2014 Feb 20.

Multicentric study on the beta-blocker use and relation with exacerbations in COPD.

Author information

1
Servicio de Neumología, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; Universidad Complutense de Madrid, Madrid, Spain. Electronic address: lpuente@separ.es.
2
Servicio de Neumología, Hospital Clínico San Carlos, Madrid, Spain.
3
Unidad de Neumología, Hospital General Nuestra Señora del Prado, Talavera de la Reina, Toledo, Spain.
4
Servicio de Neumología, Hospital Son Llàtzer (Palma de Mallorca), Spain.
5
Servicio de Neumología, Hospital Clínico Universitario, Valencia, Spain.
6
Unidad Médico Quirúrgica de Enfermedades Respiratorias, Hospital Virgen del Rocío, Sevilla, Spain; Instituto de Biomedicina de Sevilla (IBIS), Spain; Universidad Hispalense, Sevilla, Spain.
7
Complejo Hospitalario Universitario de a Coruña, Coruña, Spain.
8
Unidad Médico Quirúrgica de Enfermedades Respiratorias, Hospital Virgen del Rocío, Sevilla, Spain; Instituto de Biomedicina de Sevilla (IBIS), Spain.
9
Servicio de Neumología, Hospital Puerta Hierro, Majadahonda, Madrid, Spain.
10
Hospital de Galdakao, Vizcaya, Spain.
11
Hospital Universitario Araba, Sede Txagorritxu, Vitoria, Spain.
12
Neumología, Agencia Sanitaria Poniente Hospital de Alta Resolución de Loja, Granada, Spain.
13
Hospital Universitario "Puerto Real" (Cádiz), Spain.

Abstract

Chronic obstructive pulmonary disease (COPD) is frequently associated with chronic heart failure (CHF) or coronary artery disease (CAD). In spite of the recommendation to use beta-blockers (BB) they are likely under-prescribed to patients with concurrent COPD and heart diseases. To find out the prevalence of use of BB, 256 COPD patients were consecutively recruited by pulmonary physicians from 14 hospitals in 7 regions of Spain in their outpatient offices if they had a diagnosis of COPD, were not on long-term oxygen therapy, had CHF or CAD, and met the criteria for BB treatment. In patients with indication 58% (95%CI, 52-64%) of the COPD patients and 97% of the non-COPD patients were on BB (p < 0.001). In patients with COPD, several factors were independently related to at least one visit to the emergency room in the previous year such as use of BB, adjusted OR = 0.27 (95% CI 0.15-0.50), GOLD stage D, OR = 2.52 (1.40-4.53), baseline heart rate >70, OR 2.19 (1.24-3.86) use of long-acting beta2-agonists OR = 2.18 (1.29-3.68), previous episodes of left ventricular failure OR 2.27 (1.19-4.33) and diabetes, OR = 1.82 (1.08-3.38). We conclude that, according to what is recommended by current guidelines, BB are still under-prescribed in COPD patients. COPD patients with CHF or CAD using BB suffer fewer exacerbations and visits to the ER. GOLD stage, use of long-acting beta2-agonists, baseline heart rate and comorbidities are also risk factors for exacerbations in this population.

KEYWORDS:

Adrenergic beta-antagonists; Adverse effects; Chronic obstructive pulmonary disease; Emergency treatment; Heart failure; Myocardial infarction

PMID:
24635914
DOI:
10.1016/j.rmed.2014.02.009
[Indexed for MEDLINE]
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