CHEST Guidelines-Use-of-β-Blockers-in-COPD

Use-of-β-Blockers-in-COPD_chest

Pdf Summary

The commentary by Brian J. Lipworth and Graham Devereux discusses the use of b-blockers in COPD, particularly the potential benefits and risks of cardio-selective and nonselective b-blockers for patients suffering from cardiovascular diseases and COPD as a comorbidity. b-Adrenoceptor antagonists, widely used for heart conditions like heart failure, often raise concerns in COPD patients due to the risk of bronchoconstriction resulting from airway b2-adrenoceptor antagonism. However, cardio-selective b-blockers like bisoprolol and metoprolol, which preferentially antagonize b1 receptors over b2 receptors, may mitigate such risks.<br /><br />Recent randomized controlled trials have explored the safety and efficacy of bisoprolol and metoprolol in COPD patients. Findings indicate that bisoprolol shows higher b1:b2 selectivity, potentially offering a safer profile regarding lung function compared to metoprolol, especially when used alongside inhaled therapies like beclomethasone/formoterol. Notably, bisoprolol did not significantly worsen lung function in studies despite a mean FEV1 predictivity limitation of patients, unlike carvedilol, a nonselective b-blocker which did show some adverse effects in tests. <br /><br />A Scottish observational study found a 22% reduction in all-cause deaths for COPD patients using b-blockers. Although promising, the prospective BLOCK COPD and BICS trials aimed to further validate b1-selective antagonists' role in preventing COPD exacerbations. Both were prematurely terminated but failed to conclusively prove a reduction in exacerbations, although bisoprolol showed some promise in mortality reduction.<br /><br />Ultimately, while b-blockers do not appear to reduce COPD exacerbation risk according to these trials, bisoprolol may be beneficial in patients with severe airflow obstruction due to its selectivity. The use of a b-blocker like bisoprolol alongside long-acting muscarinic antagonists in COPD patients with cardiovascular issues remains an accepted practice, aligning with current treatment guidelines.

Keywords

b-blockers

COPD

cardio-selective

nonselective

bisoprolol

metoprolol

cardiovascular diseases

bronchoconstriction

lung function

randomized controlled trials