Intervention Review

Cardioselective beta-blockers for chronic obstructive pulmonary disease

  1. Shelley R Salpeter1,*,
  2. Thomas M Ormiston2,
  3. Edwin E Salpeter3

Editorial Group: Cochrane Airways Group

Published Online: 8 OCT 2008

Assessed as up-to-date: 17 AUG 2010

DOI: 10.1002/14651858.CD003566.pub2

Database Title

Additional Information

How to Cite

Salpeter SR, Ormiston TM, Salpeter EE. Cardioselective beta-blockers for chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews 2005, Issue 4. Art. No.: CD003566. DOI: 10.1002/14651858.CD003566.pub2.

Author Information

  1. 1

    Stanford University, Department of Medicine, Woodside, CA, USA

  2. 2

    Santa Clara Valley Medical Center, Department of Medicine, San Jose, CA, USA

  3. 3

    (Deceased), Cornell University, Ithaca, USA

*Shelley R Salpeter, Department of Medicine, Stanford University, 215 Brookwood Rd, Woodside, CA, 94062, USA. salpeter@stanford.edu.

Publication History

  1. Publication Status: New search for studies and content updated (no change to conclusions)
  2. Published Online: 8 OCT 2008

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Beta-blocker therapy has a proven mortality benefit in patients with hypertension, heart failure and coronary artery disease, as well as during the perioperative period. These drugs have traditionally been considered contraindicated in patients with chronic obstructive pulmonary disease (COPD).

Objectives

To assess the effect of cardioselective beta-blockers on respiratory function of patients with COPD.

Search methods

A comprehensive search of the Cochrane Airways Group Specialised Register (derived from systematic searches of CENTRAL, MEDLINE, EMBASE and CINAHL) was carried out to identify randomised blinded controlled trials from 1966 to August 2010. We did not exclude trials on the basis of language.

Selection criteria

Randomised, blinded, controlled trials of single dose or longer duration that studied the effects of cardioselective beta-blockers on the forced expiratory volume in one second (FEV1) or symptoms in patients with COPD.

Data collection and analysis

Two independent reviewers extracted data from the selected articles, reconciling differences by consensus. Two interventions studied were the administration of beta-blocker, given either as a single dose or for longer duration, and the use of beta2-agonist given after the study drug.

Main results

Eleven studies of single-dose treatment and 11 of treatment for longer durations, ranging from 2 days to 16 weeks, met selection criteria. Cardioselective beta-blockers, given as a single dose or for longer duration, produced no change in FEV1 or respiratory symptoms compared to placebo, and did not affect the FEV1 treatment response to beta2-agonists. Subgroup analyses revealed no significant change in results for those participants with severe chronic airways obstruction, those with a reversible obstructive component, or those with concomitant cardiovascular disease.

Authors' conclusions

Cardioselective beta-blockers, given to patients with COPD in the identified studies did not produce adverse respiratory effects. Given their demonstrated benefit in conditions such as heart failure, coronary artery disease and hypertension, cardioselective beta-blockers should not be routinely withheld from patients with COPD.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Are cardioselective beta-blockers a safe and effective treatment in patients with chronic obstructive pulmonary disease?

Long term treatment with beta-blocker medication reduces the risk of death in patients with high blood pressure, heart failure and coronary artery disease. But patients who have both COPD and cardiovascular disease sometimes do not receive these medicines because of fears that they may worsen the airways disease. This review of data from 22 randomised controlled trials on the use of cardioselective (heart-specific) beta-blockers in patients with COPD demonstrated no adverse effect on lung function or respiratory symptoms compared to placebo. This finding was consistent whether patients had severe chronic airways obstruction or a reversible obstructive component. In conclusion, cardioselective beta-blockers should not be withheld from patients with COPD.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

心臟選擇性乙型抑制劑於慢性阻塞性肺病

評估心臟選擇性乙型抑制劑對COPD病人呼吸功能的效應。

目標

對Cochrane Airways Group Specialised Register(衍生自CENTRAL、MEDLINE、EMBASE及CINAHL的系統性搜尋)進行綜合搜尋以找出自1966年至2005年5月之隨機雙盲對照試驗。我們不以語言因素排除試驗。

搜尋策略

隨機、雙盲、對照試驗探討單劑或長期使用心臟選擇性乙型抑制劑對COPD病人一秒用力呼氣容積(FEV1)或症狀的效應。

選擇標準

兩位審查者獨立地自選出的文章摘錄數據，以共識連立消除岐見。兩項介入處置進行單劑或長期使用乙型抑制劑的研究，並在給藥後使用乙型促效劑。

資料收集與分析

有11項研究使用單劑治療而有九項為長期治療(2日至12星期)符合納入條件。心臟選擇性乙型抑制劑的單劑或較長期使用與安慰劑相較並未對FEV1或呼吸症狀產生變化，亦不影響乙型促效劑的FEV1治療反應。分組分析比較嚴重氣道阻塞及有可逆性阻塞成份的病人，其結果均無改變。

主要結論

有11項研究使用單劑治療而有九項為長期治療(2日至12星期)符合納入條件。心臟選擇性乙型抑制劑的單劑或較長期使用與安慰劑相較並未對FEV1或呼吸症狀產生變化，亦不影響乙型促效劑的FEV1治療反應。分組分析比較嚴重氣道阻塞及有可逆性阻塞成份的病人，其結果均無改變。

作者結論

在找到的研究中，給予COPD患者心臟選擇性乙型抑制劑並未產生不良的呼吸效應。由於這些藥物對心臟衰竭、冠狀動脈疾病、高血壓的效益，故不應常規地排除心臟選擇性乙型抑制劑使用於COPD患者。

翻譯人

本摘要由中國醫藥大學附設醫院陳祖裕翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

乙型抑制劑的長期治療可降低高血壓、心臟衰竭及冠狀動脈疾病患者的死亡風險，然而COPD伴隨心臟血管疾病的病人卻因害怕乙型抑制劑會令呼吸道疾病惡化而很少使用這些藥物。本回顧的數據來自20項使用心臟選擇性乙型抑制劑於COPD患者之隨機對照試驗，顯示與安慰劑相較並未呈現在肺功能或呼吸症狀出現不良效應。此項發現在嚴重氣道阻塞及有可逆性阻塞成份的病人均一致。結論是：對COPD患者不應排除用於心臟選擇性乙型抑制劑。

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