From the Guidelines
Not all beta blockers are contraindicated in chronic lung disease, and cardioselective beta blockers are generally safer options for these patients. When considering the use of beta blockers in patients with chronic lung disease, it's essential to differentiate between cardioselective and non-selective beta blockers. Cardioselective beta blockers, such as metoprolol, atenolol, and bisoprolol, primarily block beta-1 receptors and have less effect on the beta-2 receptors in the lungs that control bronchodilation, reducing the risk of bronchospasm 1.
Some key points to consider when prescribing beta blockers to patients with chronic lung disease include:
- Starting with a low dose of a cardioselective agent and gradually titrating upward while monitoring for respiratory symptoms
- Regular pulmonary function monitoring
- Educating patients about potential respiratory symptoms to report
- Weighing the benefits and risks of beta blocker therapy, particularly for patients with compelling indications such as heart failure or post-myocardial infarction
According to a recent study published in 2022, beta-blocker treatment is not only safe but also reduces all-cause and in-hospital mortality in patients with COPD and cardiovascular disease 1. Additionally, cardioselective beta-blockers may even reduce COPD exacerbations. However, patients with classical pulmonary asthma may worsen their condition with the use of nonselective beta-blockers or agents with low beta 1-selectivity.
In the context of chronic lung disease, the use of beta blockers should be individualized, taking into account the specific disease, comorbidities, and potential benefits and risks of therapy. As stated in a 2022 study, beta-blockade is a key principle of treatment in medicine, and beta-blockers inhibit the actions of adrenaline and noradrenaline in various organs and systems 1. The historical absolute contraindication of beta blockers in chronic lung disease has evolved, and carefully selected and monitored beta blocker therapy can be safely administered to many patients with chronic lung disease.
From the FDA Drug Label
In general, patients with bronchospastic lung disease should not receive beta-blockers. Pulmonary function studies have been conducted in healthy volunteers, asthmatics, and patients with chronic obstructive pulmonary disease (COPD).
Not all beta blockers are contraindicated in chronic lung disease, but they should be used with caution. The decision to use beta blockers in patients with chronic lung disease should be made on a case-by-case basis, considering the potential benefits and risks. 2 3
From the Research
Beta Blockers in Chronic Lung Disease
- Not all beta blockers are contraindicated in chronic lung disease, as cardioselective beta blockers have been shown to be safe in patients with COPD 4, 5, 6.
- Cardioselective beta blockers, such as bisoprolol, metoprolol, or nebivolol, can be used in managing patients with cardiovascular diseases and COPD, but should be started at a low dose and with careful monitoring 5.
- Nonselective beta blockers may induce bronchospasm and are not recommended for COPD patients 5, 7.
- The benefit of administering selective beta blockers to patients with chronic heart failure and/or a history of myocardial infarction outweighs the potential risk related to the treatment, even in patients with severe COPD 5.
- Beta blockers should be prescribed with caution in patients with COPD, including patients with cardiac indication for beta blockers, as higher quality evidence has shown harm with their use 8.
Contraindications and Precautions
- Beta blockers are contraindicated in patients with a history of asthma, moderate to severe COPD, or those on chronic bronchodilator treatment 7.
- Patients with COPD and FEV1 reduction < 50% of the predicted value should not be given beta blockers 7.
- Beta blockers can be given to patients with COPD and FEV1 > 50% of the predicted value, providing adequate control of stability of ventilatory conditions 7.