Cardioselective beta-blockers for chronic obstructive pulmonary disease

Abstract

Background: Beta-blocker therapy has a proven mortality benefit in patients with hypertension, heart failure and coronary artery disease, as well as during the perioperative period. These drugs have traditionally been considered contraindicated in patients with chronic obstructive pulmonary disease (COPD).

Objectives: To assess the effect of cardioselective beta-blockers on respiratory function of patients with COPD.

Search strategy: A comprehensive search of the Cochrane Airways Group Specialised Register (derived from systematic searches of CENTRAL, MEDLINE, EMBASE and CINAHL) was carried out to identify randomised blinded controlled trials from 1966 to May 2005. We did not exclude trials on the basis of language.

Selection criteria: Randomised, blinded, controlled trials of single dose or longer duration that studied the effects of cardioselective beta-blockers on the forced expiratory volume in 1 second (FEV1) or symptoms in patients with COPD.

Data collection and analysis: Two independent reviewers extracted data from the selected articles, reconciling differences by consensus. Two interventions studied were the administration of beta-blocker, given either as a single dose or for longer duration, and the use of beta2-agonist given after the study drug.

Main results: Eleven studies of single-dose treatment and 9 of treatment for longer durations, ranging from 2 days to 12 weeks, met selection criteria. Cardioselective beta-blockers, given as a single dose or for longer duration, produced no change in FEV1 or respiratory symptoms compared to placebo, and did not affect the FEV1 treatment response to beta2-agonists. A subgroup analysis revealed no change in results for those participants with severe chronic airways obstruction or for those with a reversible obstructive component.

Authors' conclusions: Cardioselective beta-blockers, given to patients with COPD in the identified studies did not produce adverse respiratory effects. Given their demonstrated benefit in conditions such as heart failure, coronary artery disease and hypertension, cardioselective beta-blockers should not be routinely withheld from patients with COPD.

Conflict of interest statement

None

Figures

1.1. Analysis

Comparison 1 Beta‐blocker vs Placebo, Outcome 1 Single‐dose FEV1 treatment effect (Treatment minus Placebo, % change from baseline).

1.2. Analysis

Comparison 1 Beta‐blocker vs Placebo, Outcome 2 Single‐dose respiratory symptoms (Participants with symptoms, Treatment minus Placebo).

1.3. Analysis

Comparison 1 Beta‐blocker vs Placebo, Outcome 3 Longer duration FEV1 treatment effect (Treatment minus Placebo, % change from baseline).

1.4. Analysis

Comparison 1 Beta‐blocker vs Placebo, Outcome 4 Longer duration respiratory symptoms (Participants with symptoms, Treatment minus Placebo).

1.5. Analysis

Comparison 1 Beta‐blocker vs Placebo, Outcome 5 SUBGROUP: Severe COPD, Single‐dose FEV1 treatment effect (Treatment minus Placebo, % change).

1.6. Analysis

Comparison 1 Beta‐blocker vs Placebo, Outcome 6 SUBGROUP: Severe COPD, Longer duration FEV1 treatment effect (Treatment minus Placebo, % change).

1.7. Analysis

Comparison 1 Beta‐blocker vs Placebo, Outcome 7 SUBGROUP: Reversible airway disease, Single‐dose FEV1 treatment effect (Treatment minus Placebo, % change).

1.8. Analysis

Comparison 1 Beta‐blocker vs Placebo, Outcome 8 SUBGROUP: Reversible airway disease, Longer duration FEV1 treatment effect (Treatment minus Placebo, % change).

1.9. Analysis

Comparison 1 Beta‐blocker vs Placebo, Outcome 9 SUBGROUP: Cardiovascular conditions, Single‐dose FEV1 treatment effect (Treatment minus Placebo, % change).

1.10. Analysis

Comparison 1 Beta‐blocker vs Placebo, Outcome 10 SUBGROUP: Cardiovascular disease, Longer duration FEV1 treatment effect (Treatment minus Placebo, % change).

2.1. Analysis

Comparison 2 Beta‐blocker + agonist vs Placebo + agonist, Outcome 1 Single‐dose Beta‐agonist treatment effect (Treatment‐agonist effect minus Placebo‐agonist effect, % change).

2.2. Analysis

Comparison 2 Beta‐blocker + agonist vs Placebo + agonist, Outcome 2 Longer duration Beta‐agonist treatment effect (Treatment‐agonist effect minus Placebo‐agonist effect,% change).