Beta-blockers may have benefit in COPD patients
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Beta-blockers may help reduce exacerbation risk and improve survival in patients with chronic obstructive pulmonary disease (COPD), according to a new study.
Physicians often avoid beta-blockers in COPD patients with cardiovascular disease because of potential pulmonary complications. However, some research has indicated that beta-blockers may in fact be helpful in this population. To further examine this question, researchers performed an observational cohort study of data from 23 Dutch general medicine practices. The goal of the study, which appeared in the May 24 Archives of Internal Medicine, was to determine whether long-term use of beta-blockers improves outcomes in COPD patients with and without cardiovascular disease.
A total of 2,230 patients who had prevalent COPD at the start of the study (25%) or were diagnosed with incident COPD during follow-up (75%) were included. Fifty-three percent of patients were men, and the mean age at the beginning of the study was 64.8 years. Six hundred eighty-six patients (30.8%) died and 1,055 (47.3%) had one or more COPD exacerbations over a mean of 7.2 years of follow-up. Overall crude and adjusted hazard ratios with beta-blocker use, respectively, were 0.70 (95% CI, 0.59 to 0.84) and 0.68 (95% CI, 0.56 to 0.83) for mortality and 0.73 (95% CI, 0.63 to 0.83) and 0.71 (95% CI, 0.60 to 0.83) for exacerbations. Results were similar in patients with COPD but no evident cardiovascular disease.
The authors noted that COPD could have been incorrectly diagnosed in some study patients who actually had cardiovascular disease, among other limitations. However, they concluded that beta-blockers may reduce mortality rates and COPD exacerbations in patients with both COPD and cardiovascular disease. An accompanying editorial emphasized the need for a randomized, controlled trial to confirm the findings but said that the current study “provide[s] a rationale for the practicing clinicians to use ß-blockers (even noncardioselective ones such as carvedilol) cautiously in their patients with COPD who also have a coexisting cardiovascular condition for which a ß-blocker is required.”