title: Beta-blockers in COPD: time for reappraisal.
abstract: The combined effects on the heart of smoking and hypoxaemia may contribute to an increased cardiovascular burden in chronic obstructive pulmonary disease (COPD). The use of beta-blockers in COPD has been proposed because of their known cardioprotective effects as well as reducing heart rate and improving systolic function. Despite the proven cardiac benefits of beta-blockers post-myocardial infarction and in heart failure they remain underused due to concerns regarding potential bronchoconstriction, even with cardioselective drugs. Initiating treatment with beta-blockers requires dose titration and monitoring over a period of weeks, and beta-blockers may be less well tolerated in older patients with COPD who have other comorbidities. Medium-term prospective placebo-controlled safety studies in COPD are warranted to reassure prescribers regarding the pulmonary and cardiac tolerability of beta-blockers as well as evaluating their potential interaction with concomitant inhaled long-acting bronchodilator therapy. Several retrospective observational studies have shown impressive reductions in mortality and exacerbations conferred by beta-blockers in COPD. However, this requires confirmation from long-term prospective placebo-controlled randomised controlled trials. The real challenge is to establish whether beta-blockers confer benefits on mortality and exacerbations in all patients with COPD, including those with silent cardiovascular disease where the situation is less clear.
authors.affiliation: Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK b.j.lipworth@dundee.ac.uk.
authors.forename: Brian
authors.initials: B
authors.lastname: Lipworth
authors.affiliation: Airways Disease Section, National Heart and Lung Institute, Imperial College London, London, UK.
authors.forename: Jadwiga
authors.initials: J
authors.lastname: Wedzicha
authors.affiliation: Applied Health Sciences, University of Aberdeen, Aberdeen, UK.
authors.forename: Graham
authors.initials: G
authors.lastname: Devereux
authors.affiliation: Centre for Respiratory Medicine and Allergy, University Hospital South Manchester NHS Foundation Trust, University of Manchester, Manchester, UK.
authors.forename: Jørgen
authors.initials: J
authors.lastname: Vestbo
authors.affiliation: Lung Health Center, Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Alabama, AL, USA Birmingham VA Medical Center, Alabama, AL, USA.
authors.forename: Mark T
authors.initials: MT
authors.lastname: Dransfield
mesh_terms: D000280:Administration, Inhalation; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D001993:Bronchodilator Agents / Q000627:therapeutic use; D015897:Comorbidity; D005541:Forced Expiratory Volume / Q000187:drug effects; D006321:Heart / Q000187:drug effects / Q000502:physiology; D006333:Heart Failure / Q000150:complications; D006801:Humans; D009203:Myocardial Infarction / Q000150:complications; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy* / Q000503:physiopathology; D012129:Respiratory Function Tests
chemical_list: D000319:Adrenergic beta-Antagonists; D001993:Bronchodilator Agents