title: Beta-blockers may reduce mortality and risk of exacerbations in patients with chronic obstructive pulmonary disease.
abstract: BACKGROUND
  Physicians avoid the use of beta-blockers in patients with chronic obstructive pulmonary disease (COPD) and concurrent cardiovascular disease because of concerns about adverse pulmonary effects. We assessed the long-term effect of beta-blocker use on survival and exacerbations in patients with COPD.
  
  
  METHODS
  An observational cohort study using data from the electronic medical records of 23 general practices in the Netherlands. The data included standardized information about daily patient contacts, diagnoses, and drug prescriptions.
  
  
  RESULTS
  In total, the study included 2230 patients 45 years and older with an incident or prevalent diagnosis of COPD between 1996 and 2006. The mean (SD) age of the patients with COPD was 64.8 (11.2) years at the start of the study, and 53% of the patients were male. During a mean (SD) follow-up of 7.2 (2.8) years, 686 patients (30.8%) died and 1055 (47.3%) had at least 1 exacerbation of COPD. The crude and adjusted hazard ratios with Cox regression analysis of beta-blocker use for mortality were 0.70 (95% confidence interval [CI], 0.59-0.84) and 0.68 (95% CI, 0.56-0.83), respectively. The crude and adjusted hazard ratios for exacerbation of COPD were 0.73 (95% CI, 0.63-0.83) and 0.71 (95% CI, 0.60-0.83), respectively. The adjusted hazard ratios with the propensity score methods were even lower. Subgroup analyses revealed that patients with COPD but without overt cardiovascular disease had similar results.
  
  
  CONCLUSIONS
  Treatment with beta-blockers may reduce the risk of exacerbations and improve survival in patients with COPD, possibly as a result of dual cardiopulmonary protective properties.
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, PO Box 85060, Stratenum 6.101, 3508 AB Utrecht, the Netherlands. F.H.Rutten@umcutrecht.nl
authors.forename: Frans H
authors.initials: FH
authors.lastname: Rutten
authors.forename: Nicolaas P A
authors.initials: NP
authors.lastname: Zuithoff
authors.forename: Eelko
authors.initials: E
authors.lastname: Hak
authors.forename: Diederick E
authors.initials: DE
authors.lastname: Grobbee
authors.forename: Arno W
authors.initials: AW
authors.lastname: Hoes
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy* / Q000401:mortality*; D011788:Quality of Life; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists