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Beta-blockers found safe, beneficial in COPD

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – Beta-blockers can improve survival and reduce exacerbations of chronic obstructive pulmonary disease (COPD) – even in patients with cardiovascular disease, a new study shows.

Physicians often avoid giving beta-blockers to patients with concomitant cardiovascular disease and COPD for fear they might provoke bronchospasm and induce respiratory failure, lead author Dr. Frans H. Rutten, from University Medical Center Utrecht, the Netherlands and colleagues note in their report.

But there’s no need to avoid these agents “in COPD patients whenever there is an indication,” Dr. Rutten told Reuters Health by e-mail.

In the study subjects – “a large representative sample of patients with COPD with various cardiovascular risk profiles and a long follow-up” – use of a beta-blocker was associated with a 32% reduced risk of death (adjusted hazard ratio, 0.68) and a 29% reduced risk of COPD exacerbation (aHR, 0.71).

Dr. Rutten emphasized, however, that it’s “too early to advise prescription of beta-blockers to all COPD patients independent of whether they have cardiovascular disease or hypertension.” The current study was only observational; large randomized controlled trials would be needed before such a recommendation could be made, he said.

Dr. Rutten and colleagues reviewed medical records of 2230 men and women with COPD, aged 45 and older (average age, 64.8), including 44.9% with comorbid cardiovascular illness. When hypertension and diabetes were included, the percentage of the cohort with comorbidities rose to 66.3%.

Six hundred sixty-five patients (29.8%) received beta-blockers (mainly cardioselective ones); the other 1,565 did not.

In the May 24th issue of Archives of Internal Medicine, the researchers report that over an average of about 7 years, 686 patients died (30.8%). Death rates were higher in patients not on beta-blocker therapy (32.3% vs 27.2% in patients taking a beta-blocker; p = 0.02).

In addition, 1,055 patients (47.3%) had at least one COPD flare up during follow up. Again, this outcome was more common in patients not on a beta-blocker (49.3% vs 42.7%; p = 0.005).

Among the 1,229 patients without overt cardiovascular disease, death and COPD exacerbation were both less likely among the 239 patients on beta-blocker therapy (adjusted HR with propensity score, 0.68).

“Our study is the first that clearly gives a hint that beta-blockers could also exert pulmonary beneficial effects as shown by the reduction of exacerbations,” Dr. Rutten told Reuters Health.

In an editorial published with the study, Dr. Don D. Sin and Dr. S. F. Paul Man, of the University of British Columbia and the Providence Heart and Lung Institute, Vancouver, Canada, say this study “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.”

In e-mail to Reuters Health, Dr. Sin added: “Physicians should not withhold beta-blockers in patients with COPD if they need beta-blockers to treat their heart condition. The traditional teaching has been that beta-blockers should not be used in patients with beta-blockers. This is clearly wrong. Most COPD patients tolerate beta-blockers and will derive benefits from these drugs.”

Like Dr. Rutten, he too emphasized that until these findings can be replicated in a large well-conducted randomized controlled trial, patients without cardiovascular comorbidities “should not be given beta-blockers for their COPD.”

References:

Arch Intern Med 2010;170:849-850,880-887.