title: Rates of hospitalizations and emergency department visits in patients with asthma and chronic obstructive pulmonary disease taking beta-blockers.
abstract: OBJECTIVE
  To determine the rates of hospitalizations and emergency department (ED) visits during cardioselective and nonselective beta-blocker therapy in patients with asthma and/or chronic obstructive pulmonary disease (COPD).
  
  
  METHODS
  Retrospective, observational cohort study.
  
  
  METHODS
  Electronic medical records database.
  
  
  METHODS
  A total of 11,592 adult patients with asthma and/or COPD, identified from August 1, 1997-December 31, 2005, who were taking beta-blockers for at least 30 days or had never received a beta-blocker (controls).
  
  
  RESULTS
  Of these patients, 3062 were taking cardioselective and 690 nonselective beta-blockers; 7840 were controls. The primary end point for the beta-blocker groups was the rate of hospitalizations and ED visits/patient-year of beta-blocker therapy relative to the control group. In patients with asthma with or without concomitant COPD, cardioselective beta-blockers were associated with a relative risk of 0.89 (95% confidence interval [CI] 0.53-1.50) for hospitalizations and 1.40 (95% CI 1.20-1.62) for ED visits compared with controls. Nonselective beta-blockers were associated with a relative risk of 2.47 (95% CI 1.37-4.48) for hospitalizations and 1.21 (95% CI 0.91-1.62) for ED visits. In patients with COPD only, cardioselective beta-blockers were associated with a relative risk of 0.64 (95% CI 0.43-0.96) for hospitalizations and 1.19 (95% CI 1.02-1.39) for ED visits. Nonselective beta-blockers were associated with a relative risk of 1.02 (95% CI 0.52-2.02) for hospitalizations and 0.51 (95% CI 0.33-0.80) for ED visits.
  
  
  CONCLUSIONS
  In patients with asthma with or without COPD, both cardioselective and nonselective beta-blocker use increased hospitalizations and ED visits compared with controls. Thus, these patients should receive beta-blocker therapy only if their cardiac risk exceeds their pulmonary risk and if they have concomitant cardiac disease for which beta-blockers decrease mortality, such as previous acute myocardial infarction or chronic heart failure. In patients with COPD only, cardioselective beta-blockers slightly increased the risk of ED visits but reduced the risk of hospitalizations. Nonselective beta-blocker therapy in these patients reduced the rate of ED visits and total visits. These findings suggest a larger safety margin with beta-blocker therapy in patients with COPD only than in those with asthma with or without COPD.
authors.affiliation: St. Louis College of Pharmacy, St. Louis, Missouri 63110, USA. tbrooks@stlcop.edu
authors.forename: Tyson W A
authors.initials: TW
authors.lastname: Brooks
authors.forename: Freddy M
authors.initials: FM
authors.lastname: Creekmore
authors.forename: David C
authors.initials: DC
authors.lastname: Young
authors.forename: Carl V
authors.initials: CV
authors.lastname: Asche
authors.forename: Brian
authors.initials: B
authors.lastname: Oberg
authors.forename: Wayne M
authors.initials: WM
authors.lastname: Samuelson
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D001249:Asthma / Q000150:complications / Q000188:drug therapy*; D015331:Cohort Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006331:Heart Diseases / Q000150:complications; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000188:drug therapy*; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D000319:Adrenergic beta-Antagonists