Key result
Beta-blocker use was not associated with a significant difference in COPD exacerbation rates in either the MACRO (1.72 vs 1.71 per person-year) or STATCOPE (1.14 vs 1.34 per person-year) cohorts.
Why the study?
Does beta-blocker use affect exacerbation rates and lung function in patients with moderate to severe COPD?
Cohort (n=1,219)
Yes
Does beta-blocker use affect exacerbation rates and lung function in patients with moderate to severe COPD?
Absolute Event Rate: 1.14% vs 1.34%
Beta-blocker use in patients with moderate to severe COPD appears safe and does not adversely affect exacerbation rates or lung function, regardless of underlying cardiac comorbidities.
Supports beta-blocker safety on exacerbations in COPD; hypothesis-generating and requires randomized trials before practice change.
BACKGROUND: Beta-blockers are commonly prescribed for patients with cardiovascular disease. Providers have been wary of treating chronic obstructive pulmonary disease (COPD) patients with beta-blockers due to concern for bronchospasm, but retrospective studies have shown that cardio-selective beta-blockers are safe in COPD and possibly beneficial. However, these benefits may reflect symptom improvements due to the cardiac effects of the medication. The purpose of this study is to evaluate associations between beta-blocker use and both exacerbation rates and longitudinal measures of lung function in two well-characterized COPD cohorts. METHODS: We retrospectively analyzed 1219 participants with over 180 days of follow up from the STATCOPE trial, which excluded most cardiac comorbidities, and from the placebo arm of the MACRO trial. Primary endpoints were exacerbation rates per person-year and change in spirometry over time in association with beta blocker use. RESULTS: Overall 13.9% (170/1219) of participants reported taking beta-blockers at enrollment. We found no statistically significant differences in exacerbation rates with respect to beta-blocker use regardless of the prevalence of cardiac comorbidities. In the MACRO cohort, patients taking beta-blockers had an exacerbation rate of 1.72/person-year versus a rate of 1.71/person-year in patients not taking beta-blockers. In the STATCOPE cohort, patients taking beta-blockers had an exacerbation rate of 1.14/person-year. Patients without beta-blockers had an exacerbation rate of 1.34/person-year. We found no detrimental effect of beta blockers with respect to change in lung function over time. CONCLUSION: We found no evidence that beta-blocker use was unsafe or associated with worse pulmonary outcomes in study participants with moderate to severe COPD.
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Duffy et al. (2017) conducted a cohort in Chronic Obstructive Pulmonary Disease (COPD) (n=1,219). Beta-blockers vs. No beta-blockers was evaluated on Exacerbation rate per person-year (STATCOPE cohort). Beta-blocker use was not associated with a significant difference in COPD exacerbation rates in either the MACRO (1.72 vs 1.71 per person-year) or STATCOPE (1.14 vs 1.34 per person-year) cohorts.
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