Healthcare

Reported as May issue of Internal Medicine archives, the result of an observational cohort study said that Beta-blocker may lower the risk for exacerbations and improve survival duration in patients with Chronic Obstructive Pulmonary Disease (COPD), possibly as a result of dual cardiopulmonary protective properties.

Study author, Frans H. Rutten, MD, PhD, from University Medical Center in Utrecht, the Netherlands, and colleagues, said that they assessed the long-term effect of ?-blocker use on survival and exacerbations in patients with COPD as many physicians avoid the use of ?-blockers in patients with COPD and concurrent cardiovascular disease because of concerns about adverse pulmonary effects.

The investigator reviewed electronic medical record data including standardized information concerning daily patients contacts, diagnoses, and drug prescription among 2230 patients who were at least 45 years old from 23 general practices in the Netherlands and who had been diagnosed or were diagnosed with COPD between 1996 and 2006.

The mean age all participants was 64.8 ± 11.2 years and mean follow-up was 7.2 ± 2.8 years with 53% were men.

Overall, the study results suggest that using of ?-blockers may reduce mortality as well as the risk of exacerbations of COPD in a broad spectrum of patients with COPD with concurrent hypertension or cardiovascular disease.

The author concluded and write, “A meta-analysis or randomized trials has already shown that (cardioselective) ?-blockers are well tolerated by patients with COPD. The time has come to confirm these results in a randomized controlled trial.”

Although the study have several limitations such as misclassification of COPD, lack of spirometry in all patients, confounding by indication, and possible residual confounding, an accompanying editorial, Don D. Sin, MD, MPH, and S. F. Paul Man, MD, from the University of British Colombia and the Providence Heart and Lung Institute in Vancouver, Canada agree that a large, well-conducted, randomized controlled trial is needed to confirm the study findings, even they note that beta-blockers may unnecessarily be withheld from patient with cardiovascular conditions and comorbid COPD.

Drs. Sin and Man write, “This study provocatively suggests that the use of ?-blockers, contrary to classic teaching, is not only safe but also can prolong survival and reduce exacerbations in COPD, providing new hope for patients with COPD. These data provide a ratinale for the practicing clinicians to use ?-blockers (even noncardioselective ones such as carvedilol) cautiously in their patients with COPD who also have a coexisting cardiovascular conditions for which a beta-blocker is required. To this end, Rutten and coauthors’ study has turned the story of ?-blockers in COPD into a curious case of a foe becoming a potential friend to millions of patients with COPD worldwide.”