In patients with chronic obstructive pulmonary disease (COPD), treatment with beta-blockers is associated with reduced acute exacerbations in COPD (AECOPD) as well as reduced mortality, according to the results of a meta-analysis published in Respiratory Research. Propranolol, however, appears to be the only agent that may increase the risk of lung function deterioration.

The meta-analysis was based on a systematic review of observational studies and randomized controlled trials (RCTs) that evaluated the effects of beta-blockers vs placebo on COPD outcomes. The study authors included 23 observational studies and 14 RCTs consisting of a pooled cohort of patients with COPD, with or without cardiovascular disease (CVD). Endpoints of the analysis included all-cause mortality, AECOPD, forced expiratory volume in 1 second (FEV1), and all-cause hospitalization.

Treatment with beta-blockers in the pooled observational data was associated with an overall reduced risk of AECOPD compared with no treatment (hazard ratio [HR], 0.77; 95% CI, 0.70-0.85). Propranolol was the only individual beta-blocker that was associated with a relative reduction in FEV1 compared with placebo in a pooled cohort of 199 patients in RCTs.


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The narrative syntheses revealed a high degree of heterogeneity in terms of study design and patient characteristics. In addition, narrative syntheses found no negative effects of beta-blocker therapy on mortality, all-cause hospitalization, and quality of life.

Limitations of this meta-analysis included the inherent limitations involved in the design of the observational studies as well as the inclusion of only studies that enrolled stable patients with COPD.

The investigators of this meta-analysis suggest the choice of treatment “in patients with COPD should be made according to CVD comorbidity guidelines on management.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Gulea C, Zakeri R, Alderman V, et al. Beta-blocker therapy in patients with COPD: a systematic literature review and meta-analysis with multiple treatment comparison. Respir Res. 2021;22(1):64. doi:10.1186/s12931-021-01661-8