From the Guidelines
Beta blockers are not only safe for patients with Chronic Obstructive Pulmonary Disease (COPD) but may also reduce COPD exacerbations, as indicated by a recent meta-analysis 1. When considering the use of beta blockers in COPD patients, it's crucial to differentiate between selective and non-selective beta blockers.
- Non-selective beta blockers, which block both beta-1 and beta-2 receptors, may pose a risk of worsening bronchospasm in COPD patients.
- However, cardioselective beta blockers, such as metoprolol, atenolol, and bisoprolol, primarily target beta-1 receptors and are generally safer options for COPD patients when beta blocker therapy is necessary, as they do not affect the action of bronchodilators but reduce the heart rate acceleration caused by their use 1. Key points to consider in the management of COPD patients who require beta blocker therapy include:
- Starting with low doses and monitoring closely for respiratory symptoms.
- Educating patients to report any increase in shortness of breath, wheezing, or cough that might indicate worsening bronchospasm.
- Weighing the benefits of beta blocker therapy, such as reduced all-cause and in-hospital mortality, against the potential risks in patients with COPD and cardiovascular disease 1.
From the FDA Drug Label
Beta-blockers not only block the therapeutic effects of beta-agonists, but may produce severe bronchospasm in COPD patients. Therefore, patients with COPD should not normally be treated with beta-blockers. However, under certain circumstances, e.g., as prophylaxis after myocardial infarction, there may be no acceptable alternatives to the use of beta-blockers in patients with COPD. In this setting, cardioselective beta-blockers could be considered, although they should be administered with caution.
Beta blockers can worsen bronchospasm in COPD patients. They not only block the therapeutic effects of beta-agonists but may also produce severe bronchospasm.
- Key points:
From the Research
Beta Blockers and Bronchospasm in COPD
- Beta blockers can have varying effects on patients with Chronic Obstructive Pulmonary Disease (COPD), depending on the type of beta blocker and the individual patient's condition 4, 5, 6, 7, 8.
- Some studies suggest that cardioselective beta blockers, such as betaxolol, may be well tolerated and associated with a lower risk of acute exacerbations and death in patients with COPD 4, 5.
- Nonselective beta blockers, such as propranolol and labetalol, may worsen bronchospasm and increase the risk of severe exacerbations in patients with COPD 5, 6.
- The use of beta blockers in patients with COPD who do not have overt cardiovascular disease may not prevent COPD exacerbations and may paradoxically increase the risk of COPD-related hospitalization and mortality 4.
Effects of Specific Beta Blockers
- Propranolol has been shown to reduce FEV1 and increase airway hyperresponsiveness in patients with COPD 6.
- Metoprolol has been associated with a higher risk of severe exacerbations in patients with COPD 5.
- Betaxolol has been shown to have a lower risk of severe exacerbations and may be a preferred choice for patients with COPD who require beta blocker therapy 5.
- Bisoprolol has been associated with a dose-response survival benefit in patients with coexistent heart failure and COPD 7.
Overall Effects of Beta Blockers on COPD
- The class effect of beta blockers remains generally positive in patients with COPD, with reduced rates of acute exacerbations, mortality, and improved quality of life identified in observational studies 8.
- However, individual beta blockers may have different effects on lung function and exacerbation risk, and careful consideration should be given to the choice of beta blocker in patients with COPD 4, 5, 6, 7, 8.