Chronic obstructive pulmonary disease: beta-blockers may be associated with benefits


Patients with chronic obstructive pulmonary disease ( COPD ) may have fewer respiratory flare-ups and longer survival if they take beta-blocker medications.

Frans H Rutten at University Medical Center Utrecht, the Netherlands, studied data from electronic medical records of 2,230 patients ( average age 64.8 ) with COPD who visited 23 general medical practices between 1996 and 2006. Of these, 560 had COPD at the start of the study and 1,670 developed it during the study period; 665 used beta-blockers and 1,565 did not.

During an average of 7.2 years of follow-up, 686 patients ( 30.8% ) died, including 27.2% of those who used a beta-blocker compared with 32.3% of those who did not use a beta-blocker. In addition, 1,055 patients ( 47.3% ) had at least one exacerbation of COPD, including 42.7% of those who had used a beta blocker and 49.3% of those who did not use a beta-blocker.

Among the subgroup of 1,229 patients without overt cardiovascular disease, 520 ( 42.3% ) experienced at least one exacerbation of COPD and 241 ( 19.6% ) died. These outcomes were both less likely among the 239 patients ( 19.4% ) who used beta-blockers.

According to Authors, this is the first observational study that has shown that long-term treatment with beta-blockers may improve survival and reduce the risk of an exacerbation of COPD in the broad spectrum of patients with a diagnosis of COPD, including those who have COPD with but, importantly, also without overt cardiovascular comorbidities.
Whether beta-blockers can also cause beneficial pulmonary activity and therefore are truly cardiopulmonary drugs remains to be proved.

In an accompanying editorial, Don D. Sin and S.F. Paul Man, of the University of British Columbia and the Providence Heart and Lung Institute, Vancouver ( Canada ) wrote that although beta-blockers reduce deaths among patients with some cardiovascular conditions by 30-40%, their use is frequently withheld in patients who have co-existing COPD because clinicians fear that beta-blockers will provoke bronchospasm and induce respiratory failure in these patients.

Not surprisingly, large epidemiological studies have shown that fewer than one-third of patients with COPD receive beta-blockers after an acute coronary event despite compelling data that they prolong life and improve health outcomes in such patients.

The study by Rutten et al provocatively suggests that the use of beta-blockers, contrary to classic teaching, is not only safe but also can prolong survival and reduce exacerbations in COPD, providing new hope for patients with COPD. However, a large, well-conducted, randomized controlled trial will be needed to confirm these findings. Until then, the data by Rutten and colleagues provides a rationale for the practicing clinicians to use beta-blockers cautiously in their patients with COPD who also have a co-existing cardiovascular condition for which a beta-blocker is required.

Source: Archives of Internal Medicine, 2010

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