Underuse of beta‐blockers by patients with COPD and co‐morbid acute coronary syndrome: A nationwide follow‐up study in New Zealand

Parkin, Lianne; Quon, Joshua; Sharples, Katrina; Barson, David; Dummer, Jack

doi:10.1111/resp.13662

Cited by 8 publications

(6 citation statements)

References 26 publications

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“…Addressing cardiac comorbidity in COPD is of key interest but the role of beta‐blockers in COPD remains controversial. A nationwide study from New Zealand found only 56.6% of patients with COPD were prescribed beta‐blockers following an acute coronary syndrome 49 . This is despite a meta‐analysis of 49 studies (670 594 patients) observing reduced all‐cause mortality among COPD patients with cardiovascular disease receiving beta‐blockers (HR = 0.69 (0.58–081)) 50 .…”

Section: New Developments In Copdmentioning

confidence: 99%

Contemporary Concise Review 2020: Chronic obstructive pulmonary disease

MacDonald

Bardin

2021

Respirology

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Section: New Developments In Copdmentioning

confidence: 99%

Contemporary Concise Review 2020: Chronic obstructive pulmonary disease

MacDonald

Bardin

2021

Respirology

View full text Add to dashboard Cite

“… 3 In a study performed in New Zealand of 2637 patients with COPD and indication for β-blockers for acute coronary syndrome, only 57% of patients received such treatment. 18 …”

Section: Underuse Of β-Blockers In Copd Patientsmentioning

confidence: 99%

Certainties fading away: β-blockers do not worsen chronic obstructive pulmonary disease

Verdecchia

Cavallini

Coiro

et al. 2021

European Heart Journal Supplements

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For many years, β-blockers have been considered contraindicated in patients with heart failure (HF) and in those with bronchial asthma or even chronic obstructive pulmonary disease (COPD) although without clear evidence of asthma. Today, despite overwhelming evidence of the usefulness of β-blockers, especially in HF with reduced left ventricular ejection fraction (HFrEF), and in ischaemic heart disease, some reluctance persists in using these drugs when COPD coexists. Such resistance is due to the fear that a possible worsening of bronchospasm induced by β-blockers could induce negative effects greater than the benefits. The Guidelines of the European Society of Cardiology clearly suggest that: (i) implantation of a cardiac defibrillator (ICD) are not contraindicated in COPD without clear evidence of bronchial asthma; (ii) β-blockers are only ‘relatively’ contraindicated when there is certainty of bronchial asthma with a documented bronchodilator response to the β2 stimulant. Therefore, bronchial asthma is not an absolute contraindication to β-blockers. The cardiologist should not limit the diagnosis of COPD to clinical suspicion, but should rely on a spirometry examination associated with any bronchodilation tests. In any case, selective β1 blockers are preferred, starting at a basic dose, which ensure a better dilator response to bronchodilators and in any case cause less bronchospasm than non-selective β-blockers. Unfortunately, there is still some reluctance to the use of β-blockers in patients with COPD associated with HF, which should be eliminated.

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“…Cardioselective beta-blockers are one of the pillars of treatment for these cardiovascular diseases in the general population. However, beta-blockers are chronically underutilised for these indications in patients with COPD 3 4. This is driven by clinical concern over worsening airflow obstruction, resulting in increased breathlessness and reduced exercise capacity.…”

Section: Introductionmentioning

confidence: 99%

Bisoprolol versus celiprolol on dynamic hyperinflation, cardiopulmonary exercise and domiciliary safety in COPD: a single-centre, randomised, crossover study

et al. 2023

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BackgroundChronic obstructive pulmonary disease (COPD) is frequently associated with cardiovascular disease. The utility of beta-blockers for treating patients with COPD may be beneficial, but their safety remains uncertain, including worsening of dynamic hyperinflation (DH) during exercise. We hypothesised that among cardioselective beta-blockers celiprolol, due to its partial beta-2 agonist activity, may be safer than bisoprolol on exercise DH.MethodsWe measured isotime inspiratory capacity (IC) during cycle endurance testing in eleven moderate-severe COPD subjects, alongside other non-invasive cardiopulmonary exercise, bioreactance cardiac output, pulmonary function, biomarkers and daily domiciliary measures. Participants received titrated doses of either bisoprolol (maximim 5 mg) or celiprolol (maximum 400 mg) in randomised crossover fashion, each over 4 weeks.ResultsClinically relevant DH occurred between resting and exercise isotime IC but showed no significant difference with either beta-blocker compared with post-run-in pooled baseline or between treatments. There were no other significant differences observed for remaining exercise ventilatory; non-invasive cardiac output; resting pulmonary function; beta-2 receptor and cardiac biomarkers; domiciliary pulmonary function, oxygen saturation and symptom outcomes, either between treatments or compared with baseline. No significant adverse effects occurred.ConclusionsSignificant DH in moderate-severe COPD subjects was no different between bisoprolol or celiprolol or versus baseline. A broad spectrum of other non-invasive cardiopulmonary and domiciliary safety outcomes was equally reassuring. Bronchoprotection with a concomitant long-acting muscarinic antagonist might be an important safety measure in this context.Trial registration numberNCT02380053.

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Underuse of beta‐blockers by patients with COPD and co‐morbid acute coronary syndrome: A nationwide follow‐up study in New Zealand

Cited by 8 publications

References 26 publications

Contemporary Concise Review 2020: Chronic obstructive pulmonary disease

Contemporary Concise Review 2020: Chronic obstructive pulmonary disease

Certainties fading away: β-blockers do not worsen chronic obstructive pulmonary disease

Bisoprolol versus celiprolol on dynamic hyperinflation, cardiopulmonary exercise and domiciliary safety in COPD: a single-centre, randomised, crossover study

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