cardioselective beta blocker does not worsen COPD

Cardioselective β-blockers have been proven to reduce mortality in patients postinfarction, including patients with COPD. Despite this, some practitioners are reluctant to prescribe β-blockers in patients with COPD because of the concern that treatment will induce bronchospasm and worsen lung function, with one large multicenter observational study reporting 16% of myocardial infarction hospital survivors with COPD not receiving β-blockers on discharge. Numerous studies, however, have demonstrated that cardioselective β-blockers are safe and well tolerated in patients with COPD who have cardiovascular indications. In this population, treatment has been shown to cause no or relatively small decreases in FEV1 for patients on maintenance bronchodilator therapy (choice D is correct). In a post hoc analysis of lung function of >500 patients with moderate to severe COPD, comparing those who received β-blocker therapy with those who did not, no relevant differences were observed in trough FEV1 or results on the St. George's Respiratory Questionnaire after 52 weeks. Observational studies involving patients with severe disease who are maintained on triple therapy have also failed to demonstrate a deleterious effect of long-term β-blocker use.

A 2020 meta-analysis showed reduced all-cause mortality among patients with COPD who were taking β-blockers for cardiovascular indications (choice A is incorrect). This analysis also found that β-blockers did not lead to exacerbations of COPD and may have even reduced the risk of COPD exacerbation. Similarly, a large population-based cohort study showed the use of β-blockers after an acute myocardial infarction was associated with reduced mortality and no significant increase in COPD exacerbation risk (choice B is incorrect). Conversely, however, patients receiving β-blockers without an established indication have increased exacerbations, as demonstrated in the prospective, randomized BLOCK COPD (Beta-Blockers for the Prevention of Acute Exacerbations of Chronic Obstructive Pulmonary Disease) trial.

There is no evidence that selective β-blockers reduce the benefits of inhaled long-acting β2-agonists (choice C is incorrect). In a subgroup analysis of patients enrolled in the large, prospective SUMMIT (Study to Understand Mortality and Morbidity in COPD) trial, β-blocker therapy did not appear to attenuate the treatment benefits associated with an inhaled long-acting β2-agonist or increase the cardiovascular risk. Similarly, a subgroup analysis of the TORNADO (tiotropium plus olodaterol) studies demonstrated that patient quality of life and dyspnea were not impacted negatively by β-blockers in patients with moderate to very severe COPD on combination long-acting bronchodilator therapy.

Cardiovascular disease is a frequent comorbidity as well as a common cause of death in patients with COPD. In a review of nearly 5,000 patients with COPD admitted to a single hospital over a 10-year period, the total prevalence of cardiovascular disease in COPD patients was about 50%. For patients with COPD and cardiovascular indications, β-blockers are efficacious and should not be withheld.1

Footnotes

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