Cardiopulmonary interactions with beta-blockers and inhaled therapy in COPD

S. Jabbal, W. Anderson, P. Short, A. Morrison, A. Manoharan, B. J. Lipworth (Lead / Corresponding author)

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    14 Citations (Scopus)
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    Abstract

    Background: Beta-blockers remain underused in patients with COPD and cardiovascular disease. Aim: We compared how different inhaled therapies affect tolerability of bisoprolol and carvedilol in moderate to severe COPD. Design: A randomized, open label, cross-over study. Methods: We compared the cardiopulmonary interactions of bisoprolol 5mg qd or carvedilol 12·5 mg bid for 6 weeks in conjunction with: (a) triple: inhaled corticosteroid /long acting beta-agonist/long acting muscarinic antagonist (ICS+LABA+LAMA), (b) dual: ICS+LABA, (c) ICS alone. Results:18 patients completed, all ex-smokers, mean age 65 years, forced expiratory volume in 1 second (FEV1) 52% predicted. Bisoprolol and carvedilol produced comparable significant reduction in resting and exercise heart rate. FEV1, forced vital capacity (FVC) and lung compliance (AX) were significantly lower with carvedilol vs bisoprolol while taking concomitant ICS/LABA (P<0·05) but not ICS/LABA/LAMA. Conclusions: In summary, bisoprolol was better tolerated than carvedilol on pulmonary function at doses which produced equivalent cardiac beta-1 blockade. Worsening of pulmonary function with carvedilol was mitigated by concomitant inhaled LAMA (tiotropium) with LABA (formoterol), but not LABA alone.
    Original languageEnglish
    Pages (from-to)785-792
    Number of pages8
    JournalQJM : an International Journal of Medicine
    Volume110
    Issue number12
    Early online date24 Jul 2017
    DOIs
    Publication statusPublished - Dec 2017

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