B102-20 One Class, One Risk: Comparable Adverse Outcomes From Selective and Non-selective Beta Blockers in COPD

Introduction/Rationale Beta blockers are often avoided in acute COPD exacerbations due to concerns over bronchoconstriction, particularly with non-selective agents. While some studies suggest benefit in chronic COPD management, data remain limited for the acute setting. This study evaluates outcomes associated with beta blocker use—selective and non-selective—during hospitalization for acute COPD exacerbation. Methods We conducted a retrospective cohort study using the TriNetX Global Collaborative Network. Adults hospitalized for acute COPD exacerbation were included. Two cohorts were defined: those prescribed beta blockers within one month of the index event and those not exposed. Patients with comorbid asthma or bradycardia were excluded. After 1:1 propensity score matching to balance demographics and comorbidities, Cox proportional hazards models assessed risks of ICU admission, intubation, rehospitalization, and mortality. A secondary model evaluated outcome differences between selective and non-selective beta blockers. Results The final matched sample included 311,984 patients. Beta blocker use was significantly associated with increased risk of ICU admission (HR 2.09), intubation (HR 2.94), rehospitalization (HR 2.35), and mortality (HR 1.33) compared to controls (all p < 0.001). When stratified by beta blocker type, both selective (HR 0.902; 95% CI: 0.892-0.913) and non-selective agents (HR 0.903; 95% CI: 0.875-0.932) were associated with similar risk profiles. No statistically significant difference in outcomes was observed between selective and non-selective beta blockers. Conclusions Beta blocker use during acute exacerbation of COPD is associated with increased risk of adverse clinical outcomes. Notably, these risks do not differ between selective and non-selective beta blockers, suggesting that beta blocker selectivity may not mitigate potential harms in this context. Further prospective studies are needed to clarify causal relationships and inform safe prescribing practices.