Multicentric study on the beta-blocker use and relation with exacerbations in COPD

Puente-Maestu, Luís; Calle, Myriam; Ortega‐González, Ángel; Fuster, Antònia; González, Cruz; Martín, Eduardo Márquez; Marcos, Pedro J.; Calero, Carmen; Rodríguez-Hermosa, Juan Luis; Molina, Rosa Malo de; Aburto, Myriam; Sobradillo, Patricia; Alcázar, Bernardino; Tirado-Conde, Gema

doi:10.1016/j.rmed.2014.02.009

Cited by 35 publications

(19 citation statements)

References 33 publications

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“…Previous retrospective studies support our findings,[10 12–14 36 37] however we add to the literature by using prospectively collected data from a well characterized cohort with lung function measurements and spirometrically proven COPD. Building enthusiasm for β-blocker use was dampened by the findings of Ekstrom et al who found in a prospective observational study that β-blocker therapy increased mortality in patients with severe COPD and on home oxygen.…”

Section: Discussionsupporting

confidence: 85%

β-Blockers are associated with a reduction in COPD exacerbations

Bhatt

Wells

Kinney

et al. 2015

Thorax

112

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Background While some retrospective studies have suggested that β-blocker use in patients with chronic obstructive pulmonary disease (COPD) is associated with a reduction in the frequency of acute exacerbations and lower mortality, there is concern that their use in patients with severe COPD on home oxygen may be harmful. Methods Subjects with GOLD stage 2 to 4 COPD participating in a prospective follow-up of the COPDGene cohort, a multicenter observational cohort of current and former smokers, were recruited. Total and severe exacerbation rates were compared between groups categorized by β-blocker use on longitudinal follow-up using negative binomial regression analyses, after adjustment for demographics, airflow obstruction, %emphysema on computed tomography, respiratory medications, presence of coronary artery disease, congestive heart failure, and coronary artery calcification, and after adjustment for propensity to prescribe β-blockers. Results 3464 subjects were included. During a median of 2.1 years of follow-up, β-blocker use was associated with a significantly lower rate of total (Incidence risk ratio, IRR 0.73,95%CI 0.60 to 0.90; p=0.003) and severe exacerbations (IRR 0.67,95%CI 0.48 to 0.93; p=0.016). In those with GOLD stage 3 and 4 and on home oxygen, use of β-blockers was again associated with a reduction in the rate of total (IRR 0.33,95%CI 0.19 to 0.58; p<0.001) and severe exacerbations (IRR 0.35,95%CI 0.16 to 0.76; p=0.008). Exacerbation reduction was greatest in GOLD stage B. There was no difference in all-cause mortality with β-blocker use. Conclusions β-blockers are associated with a significant reduction in COPD exacerbations regardless of severity of airflow obstruction. The findings of this study should be tested in a randomized, placebo-controlled trial.

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Section: Discussionsupporting

confidence: 85%

β-Blockers are associated with a reduction in COPD exacerbations

Bhatt

Wells

Kinney

et al. 2015

Thorax

112

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“…In this case, among 2637 COPD patients in a large New Zealand database, with one or more admissions for acute coronary syndrome, only 57% received a beta‐blocker in the 6 months following the first admission, while 87.7% and 81% received antiplatelet therapy and a statin, respectively. This adds to the very substantial body of international data already available from large database series and observational studies, demonstrating low use of beta‐blockers in COPD patients with comorbid CVD. No further similar analyses are needed to prove this point.…”

mentioning

confidence: 77%

Too little, too late? The underuse of beta‐blockers in COPD needs evidence to address clinical uncertainty

Jenkins

2019

Respirology

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“…The results of this longitudinal study indicated that the use of beta-blockers was associated with a significant reduction in COPD exacerbations, independent of the severity of airflow obstruction. A cross-sectional study of COPD patients with chronic heart failure or coronary artery disease reported similar findings [17]. It should be noted, however, that another study found opposite results in patients in Global Initiative for Chronic Obstructive Lung Disease stages 3 and 4 on home oxygen therapy [18].…”

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confidence: 79%

Beta-blockers and COPD: the show must go on

2016

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@ERSpublications Current evidence on beta-blockers efficacy and safety in COPD is encouraging but limited with future studies needed http://ow.ly/IaNL301YANIIdentification of comorbidities is now recognised as one of the pillars for a comprehensive clinical evaluation in chronic obstructive pulmonary disease (COPD) [1]. Specifically, the burden of coexisting cardiovascular disease in COPD has gained significant attention, with specific algorithms being developed for its clinical detection [2]. The relationship between the heart and COPD is of clinical relevance not only for the well-documented relationship between the two organs [3], but also for the potential mutual influence of treatments. The interactions between oral beta-blockers and inhaled β-adrenergic drugs pose significant challenges for clinicians involved in the management of patients with chronic cardiorespiratory conditions. In particular, the use of beta-blockers in COPD remains the subject of ongoing controversy [4].In this issue of the European Respiratory Journal, LIPWORTH et al.[5] provide a comprehensive summary on the use of beta-blockers in patients with COPD. In their narrative review, the authors disentangled the complex links between COPD and the heart, reviewed the available data on the use of beta-blockers for reducing exacerbations and mortality, and summarised the unmet needs in the field, with special reference to a more in-depth knowledge of how different beta-blockers can affect pulmonary function based on their pharmacology. Despite published reports of physicians being reluctant to prescribe beta-blockers in COPD patients with a history of myocardial infarction or coexisting heart failure, the authors conclude that there are compelling reasons for the use of cardioselective beta-blockers in this patient group.In order to understand the potential implications of beta-blockers on COPD a brief review of the lung innervation and anatomical distribution of receptors in the lung is required. In humans, the direct sympathetic innervation of the airway smooth muscle is very poor [6]. Somewhat counterintuitively, however, the density of β-adrenergic receptors is markedly high and their expression can be identified in different cell types. In the human lung, β-adrenergic receptors on smooth muscle, epithelial and mast cells are of the β 2 -subtype, whose density increases towards the peripheral airways. By contrast, human submucosal glands and alveolar wall cells also express β 1 -receptors [7,8]. In the healthy heart, β 1 -and β 2 -adrenergic receptors coexist in a 4:1 ratio. However, in the failing heart, β 1 -adrenergic receptor numbers decrease, paralleled by an increase in β 2 -adrenergic receptors, ultimately resulting in a 3:2 ratio [9]. In this scenario, the occurrence of interactions may not be negligible. In general, the effects of drugs that act on adrenergic receptors depend both on the intrinsic pharmacological properties of the drug (including the β 1 /β 2 ratio) and its bioavailability (intended to be high in systemic beta-b...

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Multicentric study on the beta-blocker use and relation with exacerbations in COPD

Cited by 35 publications

References 33 publications

β-Blockers are associated with a reduction in COPD exacerbations

β-Blockers are associated with a reduction in COPD exacerbations

Too little, too late? The underuse of beta‐blockers in COPD needs evidence to address clinical uncertainty

Beta-blockers and COPD: the show must go on

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