β-Blockers May Reduce Mortality and Risk of Exacerbations in Patients With Chronic Obstructive Pulmonary Disease

Rutten, Frans H.; Zuithoff, Nicolaas P. A.; Hak, Eelko; Grobbee, Diederick E.; Hoes, Arno W.

doi:10.1001/archinternmed.2010.112

Cited by 277 publications

(253 citation statements)

References 38 publications

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“…Historically, β-blockers are not recommended because of potential respiratory adverse effects; blocking β 2 -adrenoceptors could lead to broncho constriction and worsening lung function. Evidence suggests that β 1 -selective blockers are generally well-tolerated in patients with chronic obstructive pulmonary disease and might improve survival and, paradoxically, bronchial responsiveness 85 . Given its high β 1 -selectivity, bisoprolol is the only β-blocker that is not contraindicated in chronic obstructive pulmonary disease.…”

Section: Myocardial Ischaemiamentioning

confidence: 99%

A 'diamond' approach to personalized treatment of angina

et al. 2017

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Chronic stable angina pectoris is the most prevalent symptomatic manifestation of ischaemic heart disease, and its management is a priority (BOX 1). Current clinical guidelines recommend antianginal therapy to control symptoms, before considering coronary artery revasculariza tion [1][2][3][4] . However, revascularization by either percutaneous coronary angioplasty or CABG surgery is indicated in patients who have significant artery steno sis (50% left main narrowing or proximal three-vessel disease) to reduce myocardial ischaemia and its adverse clinical manifestation. Antianginal agents are approved by documenting that they improve total exercise duration, together with a reduction in daily frequency of chronic stable angina compared with placebo and/or equivalence to an active comparator. Cardiovascular outcomes, although highly advocated, are not a pre requisite for regulatory approval. None of the antianginal drugs has been proved to reduce cardiovascular mortality or the rate of myocardial infarction. When patients are optimally treated, mortality for chronic stable angina is low, which might explain why all trials designed to improve prognosis have been negative. Guidelines recom mend a first-choice and a second-choice approach, based more on tradition and expert opinion, rather than evidence. This categorical approach has been questioned in the past couple of years 5-8 . Newer antianginal drugs, which are classified as second choice, have more evidence-based clinical data that are more contemporary to support their use than is available for the traditional first-choice drugs. Equally, the often-needed combin ation of double or triple therapy is based on expert opinion and not related to the underlying pathophysio logy. What constitutes optimal antianginal treatment, therefore, varies considerably between countries, and the majority of doctors treat their patients according to their own preconceptions.A group of experts with experience and interest in chronic stable angina met at the University of Ferrara, Italy, to discuss an individualized approach to medical treatment of chronic stable angina, on the basis E X P E RT C O N S E N S U S D O C U M E N TA 'diamond' approach to personalized treatment of angina Abstract | In clinical guidelines, drugs for symptomatic angina are classified as being first choice (β-blockers, calcium-channel blockers, short-acting nitrates) or second choice (ivabradine, nicorandil, ranolazine, trimetazidine), with the recommendation to reserve second-choice medications for patients who have contraindications to first-choice agents, do not tolerate them, or remain symptomatic. No direct comparisons between first-choice and second-choice treatments have demonstrated the superiority of one group of drugs over the other. Meta-analyses show that all antianginal drugs have similar efficacy in reducing symptoms, but provide no evidence for improvement in survival. The newer, second-choice drugs have more evidence-based clinical data that are more contemporary than is available for tr...

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Section: Myocardial Ischaemiamentioning

confidence: 99%

A 'diamond' approach to personalized treatment of angina

et al. 2017

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“…Such agents should not, therefore, be withheld from COPD patients if there is an appropriate indication [31]. Indeed, there is emerging evidence that there may be some benefit of b-blockers in COPD outside of the context of cardiovascular disease [32], although as yet, this is far from established.…”

Section: Ischemic Heart Diseasementioning

confidence: 99%

Extrapulmonary comorbidities in chronic obstructive pulmonary disease: state of the art

Patel

Hurst

2011

Expert Review of Respiratory Medicine

137

108

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“…[13][14][15][16][17] Finally, epidemiological studies and meta-analyses clearly demonstrated in non-selected COPD populations (with or without heart diseases) that BB treatment decreased mortality and acute exacerbations of COPD. [1][2][3][17][18][19][20] The possible mechanisms of the beneficial effects (cardioprotection mainly) of BB in the setting of COPD include: the presence of subclinical heart disease (ischemic heart disease, heart failure, arrhythmias etc. ), 5 the presence of clinically manifest heart disease, 10 the attenuation of cardiovascular side effects of beta-agonist medication, 11 and the correction of bronchial beta2-receptor down-regulation induced by beta-agonists.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, one of the observations regarding BB treatment was its -seemingly paradoxical -beneficial effect in case of chronic obstructive pulmonary disease (COPD). [1][2][3] This may imply changing the current paradigm, which consists in a relative contraindication of BB in COPD, due to the fact that they may cause bronchospasm.…”

Section: Introductionmentioning

confidence: 99%

Characteristics of Beta-blocker Treatment in Cardiac Patients with Concomitant Chronic Obstructive Pulmonary Disease

Frigy

Mezei

Kocsis³

et al. 2016

Journal of Interdisciplinary Medicine

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Background: Recent scientific data demonstrated a potential beneficial effect of beta-blocker (BB) therapy in cardiac patients with chronic obstructive pulmonary disease (COPD). Our aim was to characterize the use of beta-blockers in these patients, in "real-life" conditions. Material and methods: We collected retrospectively the data of 60 consecutive cardiac patients (51 men, 9 women, mean age 67 years) with the concomitant diagnosis of COPD: main cardiac conditions, presence and reason of BB therapy, type of drug and dosage, main ECG and echocardiographic parameters, medication and data regarding COPD. Besides descriptive statistics, we compared the data of patients with and without BB therapy (chi-square test, level of significance alpha <0.05) in order to identify factors associated with BB usage. Results: In our study population, 41.6% of the patients had received BB treatment, the most frequently used drug being bisoprolol 2.5 mg and 5 mg q.d. (28%-28%), followed by carvedilol (32%). The prevalence of BB therapy was 51.2% in heart failure patients (48% in NYHA class III and IV, and 66.6% in dilated cardiomyopathy), 38.4% in hypertension, 81.8% in ischemic artery disease, and 64.7% in subjects with atrial fibrillation. The usage of BB therapy was significantly associated with the presence of heart failure (p = 0.047), dilated cardiomyopathy (p = 0.034), ischemic heart disease (p = 0.005), previous myocardial infarction (p = 0.003) and, inversely, with the acute exacerbation of COPD (p = 0.006). Conclusions: Despite the fact that every cardiac patient with COPD had a potential indication for BB treatment, this was used insufficiently, especially in case of heart failure patients. In daily practice, there is a need for continuous review and improvement of BB usage in these patients.

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β-Blockers May Reduce Mortality and Risk of Exacerbations in Patients With Chronic Obstructive Pulmonary Disease

Abstract: Treatment with beta-blockers may reduce the risk of exacerbations and improve survival in patients with COPD, possibly as a result of dual cardiopulmonary protective properties.

Cited by 277 publications

References 38 publications

A 'diamond' approach to personalized treatment of angina

A 'diamond' approach to personalized treatment of angina

Extrapulmonary comorbidities in chronic obstructive pulmonary disease: state of the art

Characteristics of Beta-blocker Treatment in Cardiac Patients with Concomitant Chronic Obstructive Pulmonary Disease

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