Physicians Told to Prescribe Beta-Blockers in Patients with Obstructive Lung Disease
By John Schieszer
SEATTLE—In a complete reversal of current medical practice, a study looking at 1067 patients with congestive heart failure (CHF) has shown that beta-blockers significantly reduce mortality among patients with concomitant asthma or chronic obstructive pulmonary disease (COPD), by reducing their respiratory events.
“Unfortunately, many review articles and guidelines often list asthma and COPD as relative contraindications to beta-blockers. And many physicians are hesitant to use these medications if the patient has any history of obstructive lung disease,” said lead investigator Jay Peters, MD, of the University of Texas Health Science Center, San Antonio, who presented his findings at the meeting of the American College of Chest Physicians.
“But in our study in patients with asthma or asthma and COPD, we found that the rate of respiratory events was lower in the group of patients with obstructive lung disease taking beta-blockers compared with the group not taking beta-blockers,” he added.
During the 1960s, beta-blockers were considered contraindicated in patients with CHF; however, research in the past 5 years has revealed that the use of cardioselective beta-blockers upregulate the beta-receptor and are useful in patients with CHF. Many studies have now shown the survival benefits of beta-blockers in patients with heart disease, including CHF.
Similarly, a meta-analysis (Salpeter et al. Arch Intern Med.2002;137:715-725) that reviewed all the evidence on cardioselective beta-blockers in patients with obstructive lung disease showed that cardioselective beta-blockers were not associated with increased respiratory symptoms or increased inhaler use. In fact, some evidence suggested that these agents might even enhance the effect of inhaled beta-agonists.
However, Dr Peters said that in the 10 studies identified as adequately conducted and analyzed for the meta-analysis, the duration of beta-blocker treatment was only from 3 days to 4 weeks, and only 46 of the 141 patients analyzed had pulmonary function tests.
To investigate the long-term effects of such an approach, he and his colleagues conducted this retrospective analysis based on prospectively collected data from 1067 patients with CHF who were followed for more than 18 months, comparing medications, nonroutine office visits, emergency room visits, and hospitalizations for respiratory events.
In patients with CHF, many also had concomitant respiratory disease: 19.6% (209:1067), obstructive lung disease; 5.9%, asthma; 11.2%, COPD; 2.5%, asthma/COPD. Only 38.8% of patients with CHF and obstructive lung disease were receiving beta-blockers. About 45% of asthmatics and 35% of patients with COPD were receiving beta-blockers. In addition, <50% of patients were prescribed cardioselective beta-blockers. In this study, patients were taking beta-blockers for an average of 6.1 months.
Long-term use of beta blockade did not increase the risk of respiratory complications. “We also looked specifically at emergency room visits and hospitalizations since these can be serious and potentially life-threatening events. Again, we found no increase in adverse events in using beta-blockers in patients with obstructive lung disease,” Dr Peters emphasized.
He noted that primary care physicians may need to reevaluate the potential benefits to their patients from the use of beta-blockers in those with obstructive lung disease.