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Cardioselective beta-blockers for chronic obstructive pulmonary disease

  • Review
  • Intervention

Authors

  • SS Salpeter,

    Clinical Professor, Medicine and Director Medicine Consultation Services, Corresponding author
    1. Stanford University, and Santa Clara Valley Medical Center, Medicine, San Jose, CA, USA
    • SS Salpeter, Clinical Professor, Medicine and Director Medicine Consultation Services, Medicine, Stanford University, and Santa Clara Valley Medical Center, 2400 Moorpark Ave, Suite 118, San Jose, CA, 95128, USA. shelley.salpeter@hhs.co.santa-clara.ca.us.E Salpeter, Clinical Professor, Medicine and Director Medicine Consultation Services, Medicine, Stanford University, and Santa Clara Valley Medical Center, 2400 Moorpark Ave, Suite 118, San Jose, CA, 95128, USA. shelley.salpeter@hhs.co.santa-clara.ca.us.

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  • T Ormiston,

  • E Salpeter,

    Clinical Professor, Medicine and Director Medicine Consultation Services, Corresponding author
    1. Stanford University, and Santa Clara Valley Medical Center, Medicine, San Jose, CA, USA
    • SS Salpeter, Clinical Professor, Medicine and Director Medicine Consultation Services, Medicine, Stanford University, and Santa Clara Valley Medical Center, 2400 Moorpark Ave, Suite 118, San Jose, CA, 95128, USA. shelley.salpeter@hhs.co.santa-clara.ca.us.E Salpeter, Clinical Professor, Medicine and Director Medicine Consultation Services, Medicine, Stanford University, and Santa Clara Valley Medical Center, 2400 Moorpark Ave, Suite 118, San Jose, CA, 95128, USA. shelley.salpeter@hhs.co.santa-clara.ca.us.

    Search for more papers by this author
  • P Poole,

  • C Cates


Abstract

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 strategy

A comprehensive search of EMBASE, MEDLINE and CINAHL was performed using the Cochrane Airways Group registry to identify randomised blinded controlled trials from 1966 to May 2001. 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 1 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 8 of treatment for longer duration, ranging from 2 days to 12 weeks, met selection criteria. Cardioselective beta-blockers produced no statistically significant change in FEV1 or respiratory symptoms compared to placebo, given as a single dose (Weighted Mean Difference -2.05% [95% Confidence interval, -6.05 to 1.96%]) or for longer duration (WMD -2.55% [95% CI, -5.94 to 0.84]), and did not significantly affect the FEV1 treatment response to beta2-agonists. Exacerbations and hospitalizations were recorded in all trials, but none occurred during the periods of study, in either group. A subgroup analysis revealed no significant change in results for those participants with severe chronic airways obstruction or for those with a reversible obstructive component.

Authors' conclusions

The available evidence suggests that cardioselective beta-blockers, given to patients with COPD do not produce a significant short-term reduction in airway function or in the incidence of COPD exacerbations. However, the trials were small and of short duration. Given their demonstrated benefit in conditions such as heart failure, coronary artery disease and hypertension, cardioselective beta-blockers should be considered for patients with COPD, but administered with careful monitoring since data concerning long term administration and their effects during exacerbations are not available.

Plain language summary

Synopsis

Beta-blocker drugs to reduce the risks of hypertension and heart disease have been shown to be safe in the short term for people with COPD (chronic obstructive pulmonary disease).

Long term treatment with beta-blocker medication reduces the risk of death in patients with hypertension, heart failure and coronary artery disease, yet patients with COPD in addition to their cardiovascular disease seldom receive these medicines because of fears that they may worsen the airways disease. This review of data from 19 randomised controlled trials on the use of cardioselective 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 airways chronic airways obstruction or a reversible obstructive component. In conclusion, cardioselective beta-blockers should not be withheld from patients with COPD.

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