Beta blockers may benefit COPD patients
MedWire News: Results from a Dutch study suggest that treatment with beta blockers reduces the risk for mortality and exacerbations among patients with chronic obstructive pulmonary disease (COPD).
Frans Rutten (University Medical Center Utrecht) and colleagues explain that beta blockers have previously been shown to improve survival rates in patients with cardiovascular disease, but “many physicians avoid the use of beta blockers in patients with COPD and concurrent cardiovascular disease because of concerns about adverse pulmonary effects.”
To investigate whether there is any basis for such concerns, the researchers studied data on 2230 COPD patients, aged an average of 64.8 years, who visited 23 general medical practices between 1996 and 2006. Of these, 665 received treatment with beta blockers and 1565 did not receive these medications.
During an average follow-up period of 7.2 years, 686 patients died, including 27.2% of those who used beta blockers and 32.3% of those who did not. In addition, 1055 patients had at least one COPD exacerbation, including 42.7% of those who used beta blockers and 49.3% of those who did not.
After accounting for age, gender, smoking, cardiovascular risk factors, and other confounding factors, the researchers found that patients who used beta blockers were 32% less likely to die and 29% less likely to suffer an exacerbation during the study period than those who did not use beta blockers.
The benefits of beta-blocker treatment on mortality and exacerbation risk were similar for COPD patients with and without overt cardiovascular disease.
Rutten and team conclude in the Archives of Internal Medicine: “To our knowledge, this is the first observational study that shows that long-term treatment with beta-blockers may improve survival and reduce the risk of an exacerbation of COPD in the broad spectrum of patients with a diagnosis of COPD, including those who have COPD with but, importantly, also without overt cardiovascular comorbidities.”
They add: “Whether beta blockers can also cause beneficial pulmonary activity and therefore are truly 'cardiopulmonary' drugs remains to be proved."
In an accompanying editorial, Don Sin and Paul Man from the University of British Columbia in Vancouver, Canada, write: “The study by Rutten et al 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.
"However, before we can fully accept this notion, a large, well-conducted, randomized controlled trial will be needed to confirm these findings. Until then, the data by Rutten and colleagues provides a rationale for the practicing clinicians to use beta-blockers cautiously in their patients with COPD who also have a co-existing cardiovascular condition for which a beta blocker is required."
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By Mark Cowen