In which patient with Chronic Obstructive Pulmonary Disease (COPD) would adding a selective β1-blocker be most appropriate according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2023 executive summary report?

From the FDA Drug Label

According to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2023 executive summary report, the use of selective β1-blockers in patients with COPD is recommended for those with a history of cardiovascular disease, particularly for patients with a history of myocardial infarction or heart failure. The most appropriate patient for adding a selective β1-blocker based on the provided options would be:

• A 62-year-old recently diagnosed with heart failure with reduced ejection fraction (HFrEF) in whom guideline-directed medical therapy will be initiated This is because the patient has a clear indication for β1-blocker therapy, which is a recommended treatment for HFrEF, and the use of a selective β1-blocker is likely to be beneficial in this patient population, as stated in the GOLD 2023 executive summary report 1.

From the Research

The 62-year-old patient recently diagnosed with heart failure with reduced ejection fraction (HFrEF) would be the most appropriate candidate for adding a selective β1-blocker. This recommendation is based on the most recent and highest quality evidence, including the GOLD 2023 executive summary report and studies such as 2, which emphasize the importance of beta-blocker therapy in patients with HFrEF. The benefits of selective β1-blockers in patients with COPD who have heart failure outweigh the potential risks associated with treatment, as noted in the GOLD report. Selective β1-blockers like bisoprolol, metoprolol succinate, or nebivolol are recommended components of guideline-directed medical therapy for HFrEF and can be safely used in most COPD patients, as supported by studies such as 3 and 4. These medications have been shown to reduce mortality in heart failure patients, and their cardioselective properties minimize the risk of bronchospasm in COPD patients. When initiating therapy, it's advisable to start with a low dose (such as bisoprolol 1.25 mg daily or metoprolol succinate 12.5-25 mg daily) and gradually titrate upward while monitoring for any respiratory symptoms, as suggested by studies such as 5 and 6. Key points to consider when adding a selective β1-blocker to a patient's therapy include:

• The patient's current medication regimen and potential interactions
• The patient's respiratory status and risk of bronchospasm
• The need for gradual dose titration and monitoring of respiratory symptoms
• The importance of selecting a highly selective β1-blocker to minimize the risk of bronchospasm. Overall, the addition of a selective β1-blocker to the therapy of a patient with COPD and HFrEF is a recommended approach, as supported by the GOLD 2023 executive summary report and recent studies such as 2 and 4.