Practical recommendations for the use of beta-blockers in chronic obstructive pulmonary disease

ABSTRACT

Introduction

Controversies regarding the use of beta-blocker in chronic obstructive pulmonary disease (COPD) have been longstanding and based on inconsistent data. COPD and cardiovascular disease have many shared risk factors and potentially overlapping pathophysiologic mechanisms. Beta-blockers, a mainstay of treatment in ischemic heart disease, congestive heart failure, and cardiac arrhythmia, remain underutilized in COPD patients despite considerable evidence of safety. Furthermore, observational studies indicated the potential benefits of beta-blockers in COPD via a variety of possible mechanisms. Recently, a randomized controlled trial of metoprolol versus placebo failed to show a reduction in COPD exacerbation risk in subjects with moderate to severe COPD and no absolute indication for beta-blocker use.

Areas covered

Physiology of beta-adrenergic receptors, links between COPD and cardiovascular disease, and the role of beta-blockers in COPD management are discussed.

Expert commentary

Beta-blockers should not be used to treat COPD patients who do not have conditions with clear guideline-directed recommendations for their use. Vigilance is recommended in prescribing these medications for indications where another drug class could be utilized.

KEYWORDS:

• Beta-blocker
• COPD
• ischemic heart disease
• congestive heart failure
• arrhythmia

Article highlights

• Recognition and management of comorbidities in COPD are of paramount importance.

• Beta-blockers are underutilized in COPD patients that have other indications for use including congestive heart failure, ischemic heart disease, and arrhythmias.

• Cardioselective beta-blockers are preferable over non-cardioselective agents for use in COPD.

• Chronic use of metoprolol should not be used as a COPD exacerbation risk reduction strategy in patients with COPD at high risk for exacerbation.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

A reviewer on this manuscript has disclosed that they are a principal investigator for a new RCT of beta-blocker use in COPD patients that have experienced an exacerbation. Peer reviewers on this manuscript have no other relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.