Key result
Initiation of bisoprolol in patients with heart failure and moderate or severe COPD reduced FEV1 compared with placebo (-70 vs. +120 mL, P=0.01), without impairing symptoms or quality of life.
Why the study?
Does bisoprolol reduce FEV1 or impair health status in patients with heart failure and moderate to severe COPD?
RCT (n=27)
Randomized
Does bisoprolol reduce FEV1 or impair health status in patients with heart failure and moderate to severe COPD?
Absolute Event Rate: -70% vs 120%
p-value: p=0.01
In patients with heart failure and moderate to severe COPD, initiation of bisoprolol reduced FEV1 but did not impair symptoms, quality of life, or increase COPD exacerbations.
Bisoprolol may be initiated in HF with COPD without QoL detriment; extends RCT evidence on beta-blocker pulmonary effects.
AIMS: Heart 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 RESULTS: We 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 = 0.52). A reduction in FEV(1) occurred after 4 months following treatment with bisoprolol compared with placebo (-70 vs. +120 mL, P = 0.01). Reversibility following inhaled beta(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. -0.3, respectively), Minnesota Living with Heart Failure Questionnaire (-2.5 vs. 3.5) and Chronic Respiratory Questionnaire (0.07 vs. -0.24). The mean number of COPD exacerbations was similar in the bisoprolol and placebo groups (0.50 and 0.31, respectively, P = 0.44). CONCLUSION: Initiation 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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Hawkins et al. (2009) conducted an RCT in Heart failure and moderate to severe chronic obstructive pulmonary disease (n=27). Bisoprolol vs. Placebo was evaluated on Forced expiratory volume in 1 s (FEV1) (p=0.01). Initiation of bisoprolol in patients with heart failure and moderate or severe COPD reduced FEV1 compared with placebo (-70 vs. +120 mL, P=0.01), without impairing symptoms or quality of life.
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