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AimsHeart failure (HF) and chronic obstructive pulmonary disease (COPD) frequently coexist. No study has prospectively examined the effects of beta-blockade in those with both conditions. Methods and resultsWe randomized 27 patients with HF and coexistent moderate or severe COPD to receive bisoprolol or placebo, titrated to maximum tolerated dose over 4 months. The primary outcome was forced expiratory volume in 1 s (FEV 1 ). The study is registered with ClinicalTrials.gov, number: NCT00702156. Patients were elderly and predominantly male. Cardiovascular comorbidity, smoking history, and pulmonary function were similar in each group (mean FEV 1 1.37 vs. 1.26 L, P ¼ 0.52). A reduction in FEV 1 occurred after 4 months following treatment with bisoprolol compared with placebo (270 vs. þ120 mL, P ¼ 0.01). Reversibility following inhaled b 2 -agonist and static lung volumes were not impaired by bisoprolol. All measures of health status exhibited a consistent non-significant improvement, including the Short Form 36 physical and mental component scores (2.6 vs. 0.5 and 0.8 vs. 20.3, respectively), Minnesota Living with Heart Failure Questionnaire (22.5 vs. 3.5) and Chronic Respiratory Questionnaire (0.07 vs. 20.24). The mean number of COPD exacerbations was similar in the bisoprolol and placebo groups (0.50 and 0.31, respectively, P ¼ 0.44). ConclusionInitiation of bisoprolol in patients with HF and concomitant moderate or severe COPD resulted in a reduction in FEV 1 . However, symptoms and quality of life were not impaired.--

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