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Thorax. 2016 Jan;71(1):8-14. doi: 10.1136/thoraxjnl-2015-207251. Epub 2015 Aug 17.

β-Blockers are associated with a reduction in COPD exacerbations.

Author information

1
Division of Pulmonary, Allergy and Critical Care Medicine, UAB Lung Health Center, University of Alabama at Birmingham, Birmingham, Alabama, USA.
2
Department of Epidemiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
3
Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
4
Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California, USA.
5
Department of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.
6
Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
7
Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
8
Division of Pulmonary and Critical Care, National Jewish Health, Denver, Colorado, USA.
9
Division of Pulmonary, Allergy and Critical Care Medicine, UAB Lung Health Center, University of Alabama at Birmingham, Birmingham, Alabama, USA Birmingham VA Medical Center, Birmingham, Alabama, USA.

Abstract

BACKGROUND:

While some retrospective studies have suggested that β-blocker use in patients with COPD is associated with a reduction in the frequency of acute exacerbations and lower mortality, there is concern that their use in patients with severe COPD on home oxygen may be harmful.

METHODS:

Subjects with Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage 2-4 COPD participating in a prospective follow-up of the COPDGene cohort, a multicentre observational cohort of current and former smokers were recruited. Total and severe exacerbation rates were compared between groups categorised by β-blocker use on longitudinal follow-up using negative binomial regression analyses, after adjustment for demographics, airflow obstruction, %emphysema on CT, respiratory medications, presence of coronary artery disease, congestive heart failure and coronary artery calcification, and after adjustment for propensity to prescribe β-blockers.

RESULTS:

3464 subjects were included. During a median of 2.1 years of follow-up, β-blocker use was associated with a significantly lower rate of total (incidence risk ratio (IRR) 0.73, 95% CI 0.60 to 0.90; p=0.003) and severe exacerbations (IRR 0.67, 95% CI 0.48 to 0.93; p=0.016). In those with GOLD stage 3 and 4 and on home oxygen, use of β-blockers was again associated with a reduction in the rate of total (IRR 0.33, 95% CI 0.19 to 0.58; p<0.001) and severe exacerbations (IRR 0.35, 95% CI 0.16 to 0.76; p=0.008). Exacerbation reduction was greatest in GOLD stage B. There was no difference in all-cause mortality with β-blocker use.

CONCLUSIONS:

β-Blockers are associated with a significant reduction in COPD exacerbations regardless of severity of airflow obstruction. The findings of this study should be tested in a randomised, placebo-controlled trial.

TRIAL REGISTRATION NUMBER:

(ClinicalTrials.gov NCT00608764).

KEYWORDS:

COPD Exacerbations

Comment in

PMID:
26283710
PMCID:
PMC5154678
DOI:
10.1136/thoraxjnl-2015-207251
[Indexed for MEDLINE]
Free PMC Article

Conflict of interest statement

SPB has grant support from the American Heart Association. He has no conflicts of interest relevant to this manuscript. JMW’s institution has contracts with GSK and Forest. Dr. Wells has no conflicts of interest relevant to this manuscript. JEH receives grant support from the National Health Lung and Blood Institute and from the American Diabetes Association. Dr. Hokanson has no conflicts of interest relevant to this manuscript. In the past three years, EKS received honoraria and consulting fees from Merck and grant support and consulting fees from GSK. GRW reports receiving consulting fees from Merck and GSK. His spouse works for Merck. WCB has received personal fees from DLA Piper. MTD has served as a consultant for GSK, BI, Boston Scientific and Ikaria. His institution has received research grant support from AHA, NHLBI, GSK and Forest and has received contracted support for enrolment in clinical trials from Aeris, AstraZeneca, BI, Boston Scientific, Centocor, GSK, Forest, Otsuka, Pearl, Pfizer, PneumRx, and Pulmonx. GLK, YK, JC and HN have no conflicts of interest to declare.

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