Making a Friend of a Foe in COPD

Chronic obstructive pulmonary disease (COPD) is a common respiratory condition that affects about 14% of people over 75.  It’s a combination of two condition, emphysema and chronic bronchitis; it’s principal cause is smoking.  For years, the use of a drug class, the beta-blockers, has been discouraged in COPD patients.  When the first beta-blocker was introduced for the treatment of high blood pressure in 1964, it carried a warning stating it was contra-indicated in COPD because it caused constriction of the respiratory airways.  But then in the 1976 the so-called ‘cardio-selective’ beta-blockers were introduced.  This class of drugs had activity confined to the cardiovascular system, and were useful in high blood pressure, angina pectoris, and cardiac failure.  Even better, they didn’t cause bronchospasm.  In 12001, a Cochrane review of available evidence concluded that “Cardioselective beta-blockers given in mild to moderate reversible airway disease or COPD, do not produce adverse respiratory effects in the short term”.

Now a new study has been reported in the Archives of Internal Medicine that suggests beta-blockers have a positive therapeutic role in COPD.  

Dutch researchers analyzed electronic medical records from 2,230 COPD male and female patients over 45, with an average age of 65.  During a follow-up period of 7.2 years (on average), 686 (31%) died and 1,055 (47%) had at least one exacerbation of their COPD.  The risk of dying in those who were using a beta-blocker was 0.68-times that of those not using a beta-blocker.  Similarly, the risk of having an exacerbation of COPD in those using a beta-blocker was 0.71-times that of those not using a beta-blocker.  Interestingly, the findings were very similar in those patients with and those without obvious cardiovascular disease.

What was surprising was that the beta-blockers used were not specifically cardioselective or non-selective.  Independent editorialists write: “These data provide a rationale for practicing clinicians to use beta-blockers (even non-cardioselective ones such as carvedilol) cautiously in their patients with COPD . . .”