By Todd Kunkler
Although current evidence shows that giving beta-blockers to patients with coronary artery disease and chronic obstructive pulmonary disease (COPD) or asthma “lowers the 1-year mortality rate to a degree similar to that in patients without COPD or asthma, and without worsening respiratory function,” the authors of the article titled “Can Patients With COPD or Asthma take a Beta-Blocker,” noted that “many clinicians still hesitate to start patients with COPD or asthma on a beta-blocker due to the fear of bronchoconstriction.”
This reluctance to administer beta-blockers to this patient population may stem in part from the fact that “in patients with reversible airway disease, beta-blockers may increase airway reactivity and bronchospasm, as well as decrease the response to inhaled or oral beta-receptor agonists.” However, studies have shown that withholding beta-blockers in this population is associated with increased mortality risk; one study found that “beta-blockers were associated with a 40% reduction in mortality rates in patients with conditions often considered a contraindication to beta-blocker therapy, such as congestive heart failure, pulmonary disease, and older age.”
The author writes that cardioselective beta-blockers “with an affinity for the beta-1 receptor theoretically result in fewer adverse effects on the lungs” because they “competitively block the response to beta-adrenergic stimulation and selectively block beta-1 receptors with little or no effect on beta-2 receptors, except perhaps at high doses.” Two studies on the effect of cardioselective beta-blockers on respiratory function (one in patients with mild to moderate reactive airway disease, the other in patients with mild to severe COPD) found that although a single dose of a cardioselective beta-blocker “may produce a small decrease in FEV1 [first second of expiration],” long-term therapy with these medications “[does] not cause a significant reduction in pulmonary function in patients with mild to moderate reactive airway disease and COPD.” The author cautions that these 2 meta-analyses looked at a relatively young group of patients and only included patients with mild to moderate reactive airway disease.
Although recent studies of nonselective beta-blockers have shown that these medications can affect respiratory function in patients with COPD, these studies have failed to show any harm, according to the author. He also noted that evidence showing increased tolerability of combined nonselective beta- and alpha-blockade in patients with COPD is limited and observational.
Based on existing evidence, the author concludes that beta-blockers “improve survival rates in patients with chronic systolic heart failure and after myocardial infarction, including in those patients with coexisting COPD and reactive airway disease.” The evidence supporting the use of cardioselective beta-blockers in these patients is stronger than that for nonselective agents. However, even the use of beta-1-selective drugs “merits caution and close follow-up in patients with severe asthma.”
Author Disclosures:The authors reported no conflicts of interest.
Source: Navas EV, Taylor D. Can patients with COPD or asthma take a beta-blocker? Cleve Clin J Med. 2010;