Beta-blockers in chronic obstructive pulmonary disease – A retrospective cohort study

Background: Beta-blockers are avoided in COPD patients. Objectives: We examined the use of beta-blockers and their relationship with established stepwise pharmacological managements for COPD assessing their effects on mortality, exacerbations and pulmonary function. Methods: Retrospective cohort study using a disease specific database of COPD patients (TARDIS) linked to NHS databases providing information on hospital admissions, drug prescriptions and death. Adjusted Hazard ratios were calculated through Cox Proportional Hazard Regression after correction for covariates, including history of overt cardiovascular disease. Results: 5,977 patients, mean follow up 4.35 years, mean age 69.1 years, 88% of beta-blockers were cardio selective. There was a 22% overall reduction in all-cause mortality with beta-blocker use. Furthermore there were additive benefits of beta-blockers on all-cause mortality at all COPD treatment steps. Compared to controls the adjusted hazard ratio (95%CI) for all-cause mortality was 0.28 (95%CI, 0.21 to 0.39) for inhaled corticosteroid + long acting beta-agonist + long acting anti-muscarinic + beta-blocker verses 0.43 (95%CI, 0.38 to 0.48) without beta-blocker. There were similar trends showing additive benefits of beta-blockers in reducing oral steroid use and respiratory hospital admissions. Beta-blockers had no deleterious impact on FEV 1 or FVC at all treatment steps when given with a LABA or LAMA. Conclusions: Our study suggests beta-blockers may reduce mortality and exacerbations when added to established inhaled stepwise therapy for COPD, independently of overt cardiovascular disease and cardiac medications, and without adverse effects on pulmonary function.