NEW YORK (Reuters Health) – The use of cardioselective beta-blockers can improve survival in “carefully selected” COPD patients undergoing vascular surgery, according to a report in the first October issue of the American Journal of Respiratory and Critical Care Medicine.

Clinicians are often reluctant to prescribe beta-blockers to COPD patients out of fear that they will induce bronchoconstriction and exacerbate their disease, the report explains. While this may be true with non-selective beta-blockers, there is evidence that the cardioselective beta-blockers, which have little impact on the beta2-adrenoreceptors that affect airway patency, are safe and beneficial in COPD patients with heart disease.

“Beta-blockers used to be considered contraindicated in the COPD population,” senior author Dr. Don Poldermans, from Erasmus Medical Center in Rotterdam, the Netherlands, told Reuters Health. The current findings, however, suggest that cardioselective beta-blockers, such as bisoprolol and atenolol, may actually reduce mortality in COPD patients with atherosclerosis. So, “the contraindication might turn into an indication.”

The study featured 3371 consecutive patients who underwent vascular surgery at one center from 1990 to 2006. Symptom status and spirometry results were used to divide the patients into COPD and non-COPD groups.

Overall, 1310 patients (39%) had COPD, including 462 (35%) who were treated with a cardioselective beta-blocking agent, the authors note.

In the analysis of all COPD patients, cardioselective beta-blocker use cut 30-day and 10-year mortality by 63% and 27%, respectively. With mild COPD, the corresponding reductions were 64% and 32% and with moderate/severe COPD, 68% and 18%. Similar mortality reductions were noted in non-COPD patients.

Only beta-blockers dosages given at hat were at least 25% of the maximum recommended therapeutic dosage had a beneficial effect on mortality.

The authors of a related editorial note that while the current findings are reassuring, beta-blockers should continue to be used with caution in COPD patients.

Dr. Mario Cazzola, from the University of Rome, and Dr. Maria Gabriella Matera, from the Second University of Naples, comment that “although beta-blockers can be introduced in any medical setting, it still seems appropriate to use cardioselective beta-blockers in patients with COPD at the lowest dose and to titrate slowly with attention to lung function and symptoms.”

Reference:
Am J Respir Crit Care Med 2008;178.