Abstract
BackgroundDespite the benefits of beta-blockers in patients with established or sub-clinical coronary artery disease, their use in patients with chronic obstructive pulmonary disease (COPD) has been controversial. Currently, no systematic review has examined the impact of beta-blockers on mortality in COPD.MethodsWe systematically searched electronic bibliographic databases including MEDLINE, EMBASE and Cochrane Library for clinical studies that examine the association between beta-blocker use and all cause mortality in patients with COPD. Risk ratios across studies were pooled using random effects models to estimate a pooled relative risk across studies. Publication bias was assessed using a funnel plot.ResultsOur search identified nine retrospective cohort studies that met the study inclusion criteria. The pooled relative risk of COPD related mortality secondary to beta-blocker use was 0.69 (95% CI: 0.62-0.78; I2=82%).ConclusionThe results of this review are consistent with a protective effect of beta-blockers with respect to all cause mortality. Due to the observational nature of the included studies, the possibility of confounding that may have affected these results cannot be excluded. The hypothesis that beta blocker therapy might be of benefit in COPD needs to be evaluated in randomised controlled trials.
Highlights
Despite the benefits of beta-blockers in patients with established or sub-clinical coronary artery disease, their use in patients with chronic obstructive pulmonary disease (COPD) has been controversial
This means that studies that did not find a protective association for beta-blockers and mortality in COPD patients were less likely to be published
The mortality benefit from this review is similar in magnitude to that of statins which have been previously studied in this setting [21,22] and are currently being tested in randomised controlled trials [23]
Summary
Despite the benefits of beta-blockers in patients with established or sub-clinical coronary artery disease, their use in patients with chronic obstructive pulmonary disease (COPD) has been controversial. Beta-blockers are one of the most prescribed classes of cardiovascular medications In clinical trials they have been shown to lower morbidity and mortality secondary to congestive heart failure [1] (CHF) and coronary artery disease (CAD) [2]. There has been uncertainty with regard to using beta-blockers in COPD patients mainly because of concerns that they might induce bronchospasm and worsen lung function [4], especially in those patients who have a combination of asthma and COPD. In one systematic review of 19 randomised controlled trials that included patients with both asthma and COPD, beta-blockers lowered FEV1 by 7.46% (95% CI, 5.59%-9.32%) [4]. Results from this meta-analysis prompted guidelines to recommend the use of low dose beta-blockers in COPD patients [7]
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