Beta-blockers in chronic obstructive pulmonary disease: the good, the bad and the ugly.

ABSTRACT

PURPOSE OF REVIEW Several observational studies have suggested that ß-blockers, especially cardioselective ones, are well tolerated and associated with a lower risk of acute exacerbations and death in patients with chronic obstructive pulmonary disease (COPD). However, there are dissenting studies. This review provides an update on the use of ß-blockers in COPD, focusing on results of recent prospective studies and randomized controlled trials. RECENT FINDINGS: In totality, cohort studies indicate that ß-blockers are generally well tolerated and effective in COPD patients who also have a clear cardiovascular indication for these medications. Although ß-blockers on average reduce lung function acutely in COPD patients, the absolute decrease is relatively small, especially if cardioselective ß-blockers are used. The results of two large randomized controlled trials suggest that ß-blocker use does not reduce the therapeutic benefits of inhaled bronchodilators in COPD patients. The use of ß-blockers in COPD patients, who do not have overt cardiovascular disease, does not prevent COPD exacerbations and may paradoxically increase the risk of COPD-related hospitalization and mortality. SUMMARY: The use of ß-blockers is generally well tolerated and effective in COPD patients, who also have a clear cardiovascular indication for these drugs. However, they should not be used in patients who do not have overt cardiovascular disease as ß-blockers can reduce lung function, worsen health status and increase the risk of COPD-related hospitalization.