Differences among beta-blockers for the treatment of patients with heart failure and chronic obstructive pulmonary disease

Abstract

Although current guidelines support the use of beta-blockers (BB) in all patients with symptomatic heart failure (HF) and left ventricular systolic dysfunction, unless contraindicated or not tolerated, they are still underused, especially in patients with chronic obstructive pulmonary disease (COPD). BB are associated with a potential risk for lung function decline and airway hyperresponsiveness, and reluctance still exists to prescribe these agents in COPD patients. However, a large body of evidence indicates that these patients tolerate well selective beta-blockade, and BB should not be denied to HF patients with concomitant COPD. Current guidelines and recent reports recommend the use of selective BB in all patients with stable COPD and irreversible airway obstruction, to be administered at the lowest dose and at a low titration rate. Close monitoring of lung function by spirometry is strongly encouraged to guide and enhance a safe BB use in everyday practice. Pneumologists and cardiologists should develop shared strategies with the aim to implement selective BB therapy in clinical practice and improve the prognosis of both HF and COPD.