LSC Abstract – Potential use of β-blockers to reduce COPD exacerbations

Abstract

BACKGROUND: While β-blockers are known to be protective in patients with cardiovascular disease, retrospective studies have suggested that β-blockers also have beneficial effects in patients with COPD. AIM: To investigate whether (cardioselective) β-blockers have a beneficial effect on the risk of COPD exacerbations. METHODS: This nested case-control study is embedded within the Rotterdam Study, a prospective population-based cohort study among 15 000 subjects aged 45 years and older with long-term follow-up (up to 25 years). COPD subjects were followed until the first moderate to severe COPD exacerbation. A Cox proportional hazards regression analyses was conducted adjusting for age, sex, smoking status and all factors that changed the matched estimate with 10%. A stratified analysis was conducted in patients with or without heart failure. RESULTS: Within the cohort of 1 621 COPD patients, 1 136 patients developed COPD exacerbations during 11 600 person years of follow-up (of which 268 exacerbations were severe). Current use of β-blockers was associated with a 21% reduced risk of COPD exacerbations (HR 0.79, 95%CI 0.67-0.94), driven by the use of cardioselective β-blockers (HR 0.79, 95CI% 0.65-0.95), while no protective effect was observed for non-cardioselective β-blockers though numbers were low (HR 1.01, 95CI% 0.66-1.56). This association was strongest for COPD patients with heart failure (n=109; HR 0.45 95% CI 0.23-0.87). CONCLUSION: Use of cardioselective β-blockers is associated with a reduced risk of COPD exacerbations. Further research should reveal whether this association is causal or due to confounding, and whether reduced exacerbation risk translates in reduced mortality. This abstract has been presented previously at the European Respiratory Society9s Lung Science Conference in March 2016.