Call for greater beta blocker use in COPD

Researchers say that stubbornly low rates of beta-blocker prescribing in patients with chronic obstructive pulmonary disease (COPD) could be contributing toward increased mortality in these patients following myocardial infarction.

Jennifer Quint (London School of Hygiene and Tropical Medicine, UK) and colleagues found that COPD patients who started beta-blocker treatment at the time of hospital admission had a 50% lower risk for death than those who did not receive any beta-blocker treatment. Patients who were already taking the medication before myocardial infarction also experienced a survival benefit.

However, with less than 40% receiving a beta blocker during their hospital stay, the team suggests that physicians may be unduly cautious about prescribing the drugs in COPD patients.

“Despite increasing evidence that ß blockers are safe and can actually be beneficial in patients with COPD, even beyond cardiovascular properties, their use continues to be limited in this group,” they note.

“This is a worldwide phenomenon and might be related to historical concerns that ß blockers could be harmful in patients with COPD (for example, by inducing bronchospasm).”

The researchers used data from two national databases to identify patients with COPD who experienced their first myocardial infarction between 2003 and 2008; 1063 patients were included in the analysis. During a median follow-up of 2.9 years, 50.2% of patients who never took a beta blocker died, compared with 38.9% of those receiving a beta blocker before myocardial infarction, and 24.9% of those newly receiving one during hospital admission.

After adjusting for confounders, these latter patients were 50% less likely to die than those never prescribed a beta blocker, and those who had been prescribed a beta blocker before admission also had a 41% lower risk for death.

The team observed a similar magnitude of effect of beta-blocker prescription on noncardiac and cardiac deaths.

Writing in the BMJ, Quint and colleagues say that the lack of beta blocker use in patients with COPD may be contributing toward the increased mortality seen in these patients following myocardial infarction. In particular, they note that patients with the most frequent exacerbations may be the least likely to receive beta blockers due to physician concerns about bronchospasm, despite having the greatest risk for cardiovascular comorbidity.

“There is evidence that ß blockers do not detrimentally affect lung function in patients with COPD and thus severity of disease or the lack of spirometry at the time of hospital admission for myocardial infarction should not deter their prescription,” they conclude.

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