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Eur Respir J. 2016 Sep;48(3):880-8. doi: 10.1183/13993003.01847-2015. Epub 2016 Jul 7.

Beta-blockers in COPD: time for reappraisal.

Author information

1
Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK b.j.lipworth@dundee.ac.uk.
2
Airways Disease Section, National Heart and Lung Institute, Imperial College London, London, UK.
3
Applied Health Sciences, University of Aberdeen, Aberdeen, UK.
4
Centre for Respiratory Medicine and Allergy, University Hospital South Manchester NHS Foundation Trust, University of Manchester, Manchester, UK.
5
Lung Health Center, Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Alabama, AL, USA Birmingham VA Medical Center, Alabama, AL, USA.

Abstract

The combined effects on the heart of smoking and hypoxaemia may contribute to an increased cardiovascular burden in chronic obstructive pulmonary disease (COPD). The use of beta-blockers in COPD has been proposed because of their known cardioprotective effects as well as reducing heart rate and improving systolic function. Despite the proven cardiac benefits of beta-blockers post-myocardial infarction and in heart failure they remain underused due to concerns regarding potential bronchoconstriction, even with cardioselective drugs. Initiating treatment with beta-blockers requires dose titration and monitoring over a period of weeks, and beta-blockers may be less well tolerated in older patients with COPD who have other comorbidities. Medium-term prospective placebo-controlled safety studies in COPD are warranted to reassure prescribers regarding the pulmonary and cardiac tolerability of beta-blockers as well as evaluating their potential interaction with concomitant inhaled long-acting bronchodilator therapy. Several retrospective observational studies have shown impressive reductions in mortality and exacerbations conferred by beta-blockers in COPD. However, this requires confirmation from long-term prospective placebo-controlled randomised controlled trials. The real challenge is to establish whether beta-blockers confer benefits on mortality and exacerbations in all patients with COPD, including those with silent cardiovascular disease where the situation is less clear.

Comment in

PMID:
27390282
DOI:
10.1183/13993003.01847-2015
[Indexed for MEDLINE]
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