Beta-Blockers In Chronic Obstructive Pulmonary Disease: The Good, The Bad And The Ugly

Purpose of reviewSeveral observational studies have suggested that beta-blockers, especially cardioselective ones, are well tolerated and associated with a lower risk of acute exacerbations and death in patients with chronic obstructive pulmonary disease (COPD). However, there are dissenting studies. This review provides an update on the use of beta-blockers in COPD, focusing on results of recent prospective studies and randomized controlled trials.Recent findingsIn totality, cohort studies indicate that beta-blockers are generally well tolerated and effective in COPD patients who also have a clear cardiovascular indication for these medications. Although beta-blockers on average reduce lung function acutely in COPD patients, the absolute decrease is relatively small, especially if cardioselective beta-blockers are used. The results of two large randomized controlled trials suggest that beta-blocker use does not reduce the therapeutic benefits of inhaled bronchodilators in COPD patients. The use of beta-blockers in COPD patients, who do not have overt cardiovascular disease, does not prevent COPD exacerbations and may paradoxically increase the risk of COPD-related hospitalization and mortality.SummaryThe use of beta-blockers is generally well tolerated and effective in COPD patients, who also have a clear cardiovascular indication for these drugs. However, they should not be used in patients who do not have overt cardiovascular disease as beta-blockers can reduce lung function, worsen health status and increase the risk of COPD-related hospitalization.