The effect of the indicated use of ß-blockers on the risk of COPD exacerbations: the Rotterdam Study

Abstract

Background: While observational studies suggest a reduced risk of exacerbation in COPD patients treated with β-blockers (BB), there is reluctance to prescribe BB in patients with cardiovascular disease (CVD) and concomitant COPD. Recently, the BLOCK COPD trial reported an increased risk of exacerbation in metoprolol treated COPD patients without a therapeutic indication (TI) for such drug. The current discrepancy between findings from observational studies and the BLOCK COPD trial might result in even less prescribing BB in COPD patients with a cardiac indication. Aim: To examine whether the association between use of BB and risk of COPD exacerbations differed between patients with and without a TI for BB use. Methods: Within the Rotterdam Study, we followed 1,312 COPD subjects until the first COPD exacerbation or end of follow-up. We defined TI for BB use as having hypertension, coronary heart disease, atrial fibrillation, or heart failure at baseline. The association between BB use, as a time-varying variable, and COPD exacerbations was assessed using Cox proportional hazards models adjusted for age, sex, smoking, and other potential confounders. Results: In patients with a TI for BB (n=755, mean age=70.4±9) current use of cardioselective BB (CSBB) was associated with a reduced risk of COPD exacerbations (HR=0.69, 95%CI:0.57-0.85). In contrast, in subjects without a TI for BB (n=557, mean age=68.8±10) use of CSBB was not associated with an altered risk of COPD exacerbations. Conclusion: Use of CSBB reduced the risk of exacerbations only in COPD patients with concomitant CVD. Our results could explain the discordant findings between the BLOCK COPD trial and observational studies.