Beta-Blockers Safe in COPD With Cardiovascular Comorbidities

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There was a trend toward a reduction in mortality in patients with COPD who received beta-blocker treatment compared with patients who did not.

This article is part of Pulmonology Advisor‘s coverage of the CHEST 2018 meeting, taking place in San Antonio, Texas. Our staff will report on medical research related to COPD, critical care medicine, and more conducted by experts in the field. Check back regularly for more news from CHEST 2018.

SAN ANTONIO — Treatment with beta blockers appears to be safe in patients with chronic obstructive pulmonary disease (COPD) and cardiovascular comorbidities, conferring a trend toward a reduction in all-cause mortality compared with no beta-blockers, according to findings presented at the CHEST Annual Meeting, held October 6-10, 2018, in San Antonio, Texas.

Beta-blockers have previously been shown to effectively decrease mortality in patients with cardiovascular disease, but concerns linger about their use in COPD because some clinicians believe beta-blockers trigger bronchoconstriction and exacerbations that may increase risk for death despite recommendations to the contrary. To assess these claims and those supporting the use of beta-blockers, researchers conducted a meta-analysis on the effects of beta-blockers in reducing all-cause mortality in patients with COPD.

The review included 22 prospective and retrospective cohort studies (N=98,813) that examined mortality in patients with COPD who were and were not given beta-blockers. However, since no randomized controlled trials exist on this issue, none were included. All-cause mortality was the primary outcome, while the secondary outcome consisted of a comparison between mortality and cardio-selectivity of beta-blockers used, as well as COPD exacerbations.

The researchers found a trend toward a reduction in mortality (relative risk [RR] 0.79; 95% CI, 0.58-1.06) in patients with COPD who received beta-blocker treatment compared with patients who did not. Patients who were given cardio-selective beta-blockers trended toward lower mortality (RR 0.83; 95% CI, 0.5-1.20) compared with patients who received non-selective beta-blockers, who trended toward increased mortality (RR 1.12; 95% CI, 0.71-1.75).

“Interestingly, the beta-blocker group had a 12% significantly lower exacerbations RR 0.88 (0.79-0.98) compared [with] those not given beta-blockers,” the researchers wrote. All outcomes were considered significantly heterogeneous.

The researchers urged healthcare professionals to be aware that cardio-selective beta-blocker therapy can be safely administered to patients with COPD, “provided that adequate monitoring and observation is coupled with standard medical care.”

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Further studies, such as randomized clinical trials, are required to firmly establish these recommendations.

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Tan IR, Villalobos RE, Divinagracia RM. Safety and benefits of beta-blockers in COPD: a review of current evidence and meta-analysis. Presented at: CHEST Annual Meeting 2018; October 6-10, 2018; San Antonio, TX.