title: Multicentric study on the beta-blocker use and relation with exacerbations in COPD.
abstract: Chronic obstructive pulmonary disease (COPD) is frequently associated with chronic heart failure (CHF) or coronary artery disease (CAD). In spite of the recommendation to use beta-blockers (BB) they are likely under-prescribed to patients with concurrent COPD and heart diseases. To find out the prevalence of use of BB, 256 COPD patients were consecutively recruited by pulmonary physicians from 14 hospitals in 7 regions of Spain in their outpatient offices if they had a diagnosis of COPD, were not on long-term oxygen therapy, had CHF or CAD, and met the criteria for BB treatment. In patients with indication 58% (95%CI, 52-64%) of the COPD patients and 97% of the non-COPD patients were on BB (p < 0.001). In patients with COPD, several factors were independently related to at least one visit to the emergency room in the previous year such as use of BB, adjusted OR = 0.27 (95% CI 0.15-0.50), GOLD stage D, OR = 2.52 (1.40-4.53), baseline heart rate >70, OR 2.19 (1.24-3.86) use of long-acting beta2-agonists OR = 2.18 (1.29-3.68), previous episodes of left ventricular failure OR 2.27 (1.19-4.33) and diabetes, OR = 1.82 (1.08-3.38). We conclude that, according to what is recommended by current guidelines, BB are still under-prescribed in COPD patients. COPD patients with CHF or CAD using BB suffer fewer exacerbations and visits to the ER. GOLD stage, use of long-acting beta2-agonists, baseline heart rate and comorbidities are also risk factors for exacerbations in this population.
authors.affiliation: Servicio de Neumología, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; Universidad Complutense de Madrid, Madrid, Spain. Electronic address: lpuente@separ.es.
authors.forename: Luis
authors.initials: L
authors.lastname: Puente-Maestu
authors.affiliation: Servicio de Neumología, Hospital Clínico San Carlos, Madrid, Spain.
authors.forename: Myriam
authors.initials: M
authors.lastname: Calle
authors.affiliation: Unidad de Neumología, Hospital General Nuestra Señora del Prado, Talavera de la Reina, Toledo, Spain.
authors.forename: Angel
authors.initials: A
authors.lastname: Ortega-González
authors.affiliation: Servicio de Neumología, Hospital Son Llàtzer (Palma de Mallorca), Spain.
authors.forename: Antonia
authors.initials: A
authors.lastname: Fuster
authors.affiliation: Servicio de Neumología, Hospital Clínico Universitario, Valencia, Spain.
authors.forename: Cruz
authors.initials: C
authors.lastname: González
authors.affiliation: Unidad Médico Quirúrgica de Enfermedades Respiratorias, Hospital Virgen del Rocío, Sevilla, Spain; Instituto de Biomedicina de Sevilla (IBIS), Spain; Universidad Hispalense, Sevilla, Spain.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Márquez-Martín
authors.affiliation: Complejo Hospitalario Universitario de a Coruña, Coruña, Spain.
authors.forename: Pedro Jorge
authors.initials: PJ
authors.lastname: Marcos-Rodriguez
authors.affiliation: Unidad Médico Quirúrgica de Enfermedades Respiratorias, Hospital Virgen del Rocío, Sevilla, Spain; Instituto de Biomedicina de Sevilla (IBIS), Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Calero
authors.affiliation: Servicio de Neumología, Hospital Clínico San Carlos, Madrid, Spain.
authors.forename: Juan Luis
authors.initials: JL
authors.lastname: Rodríguez-Hermosa
authors.affiliation: Servicio de Neumología, Hospital Puerta Hierro, Majadahonda, Madrid, Spain.
authors.forename: Rosa
authors.initials: R
authors.lastname: Malo de Molina
authors.affiliation: Hospital de Galdakao, Vizcaya, Spain.
authors.forename: Myriam
authors.initials: M
authors.lastname: Aburto
authors.affiliation: Hospital Universitario Araba, Sede Txagorritxu, Vitoria, Spain.
authors.forename: Patricia
authors.initials: P
authors.lastname: Sobradillo
authors.affiliation: Neumología, Agencia Sanitaria Poniente Hospital de Alta Resolución de Loja, Granada, Spain.
authors.forename: Bernardino
authors.initials: B
authors.lastname: Alcázar
authors.affiliation: Hospital Universitario "Puerto Real" (Cádiz), Spain.
authors.forename: Gema
authors.initials: G
authors.lastname: Tirado-Conde
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D000368:Aged; D000369:Aged, 80 and over; D001993:Bronchodilator Agents / Q000627:therapeutic use; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000188:drug therapy* / Q000453:epidemiology; D003430:Cross-Sectional Studies; D004363:Drug Utilization / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology* / Q000209:etiology; D012307:Risk Factors; D012720:Severity of Illness Index; D013030:Spain / Q000453:epidemiology
chemical_list: D000319:Adrenergic beta-Antagonists; D001993:Bronchodilator Agents
keywords: Adrenergic beta-antagonists; Adverse effects; Chronic obstructive pulmonary disease; Emergency treatment; Heart failure; Myocardial infarction