Beta-blockers in COPD: time for reappraisal

Brian Lipworth (Lead / Corresponding author), Jadwiga Wedzicha, Graham Devereux, Jørgen Vestbo, Mark T. Dransfield

Research output: Contribution to journalArticlepeer-review

40 Citations (Scopus)
144 Downloads (Pure)

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.

Original languageEnglish
Pages (from-to)880-888
Number of pages9
JournalEuropean Respiratory Journal
Volume48
Issue number3
Early online date7 Jul 2016
DOIs
Publication statusPublished - 1 Sep 2016

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