Beta blockers are widely prescribed for a range of conditions and are now widely used in the management of cardiovascular disease. Patients with chronic obstructive pulmonary disease (COPD) often have concurrent co-morbidities including cardiovascular disease. However there has been concerns regarding the prescription β-blockers in these patients due to worries about the effect it may have on their respiratory function:
- evidence that the use of β-blockers in patients with COPD may lead to a reduction in their lung function (by reducing their FEV1 - Forced expiratory volume in one second)
- β-blockers may increase airway hyperresponsiveness
One of the mainstays of treatment of COPD is the use of beta-agonists and there have been concerns that β-blockers may lead to inhibition of the bronchodilator response to these drugs.
As such there has been some reluctance to prescribe β-blockers in these patients. This paper published in the BMJ looked at the use of β-blockers in patients with COPD to assess the effect on mortality, hospital admissions and exacerbations when used in combination with established therapy for COPD.
This was a retrospective cohort study which identified cases from a disease-specific database in Tayside which is used by GPs and secondary care respiratory physicians. All patients fulfil the GOLD guidelines for diagnosis of COPD and data on these patients was collected by respiratory nurses at yearly visits. The authors then identified patients who had an admission to hospital due to COPD and also gathered data on the prescription of respiratory and cardiovascular drugs and on deaths from the general register.
The main outcome measures were hazard ratios from all cause mortality, emergency oral corticosteriod use (use to treat exacerbations of COPD) and respiratory related hospital admissions. In these patients 88% of the β-blockers used were cardioselective.
The results – this paper showed a 22% reduction in all cause mortality in patients prescribed β-blockers. There was a reduction in the adjusted hazard ratio for patients prescribed β-blockers with standard treatment for COPD compared to those who weren’t (0.28 vs 0.43). The paper also showed a reduction in oral corticosteriod use and hospital admission. There was no adverse effect on lung function detected at all stages of the stepwise treatment approach to COPD.
The authors of this paper concluded that:
β blockers may reduce mortality and COPD exacerbations when added to established inhaled stepwise therapy for COPD, independently of overt cardiovascular disease and cardiac drugs, and without adverse effects on pulmonary function
A list of discussion points will be posted shortly. Thank you to @amcunningham for suggesting this paper.