Introduction: beta-Blockers are known to worsen FEV1 and airway hyperresponsiveness (AHR) in patients with asthma. Both characteristics determine the outcome of COPD, a disease with frequent cardiac comorbidity requiring beta-blocker treatment.
Design: A double-blind, placebo-controlled, randomized, cross-over study.
Setting: An ambulatory, hospital outpatient clinic of pulmonary diseases.
Patients: Patients with mild-to-moderate irreversible COPD and AHR.
Intervention: Fifteen patients received propranolol (80 mg), metoprolol (100 mg), celiprolol (200 mg), or placebo for 4 days, followed by a washout period >= 3 days. On day 4 of treatment, FEV1 and PC20 were assessed. Immediately hereafter, formoterol (12 mu g) was administered and FEV1 was measured for up to 30 min.
Results: PC20 was significantly lower (p <0.01) with propranolol and metoprolol treatment (geometric means, 2.06 mg/mL and 2.02 mg/mL, respectively) than with placebo (3.16 mg/mL) or celiprolol (3.41 mg/mL). FEV1 deteriorated only after propranolol treatment (2.08 +/- 0.31 L) [mean +/- SD] compared with placebo (2.24 +/- 0.37 L). The fast bronchodilating effect of formoterol was hampered by propranolol (mean increase in FEV1 at 3 min, 6.7 +/- 8.9%) but was unaffected by the other beta-blockers (16.9 +/- 9.8%, 22 +/- 11.6%, and 16.9 +/- 9.0% for placebo, metoprolol, and celiprolol, respectively).
Conclusions: Pulmonary effects did not occur by celiprolol. Only propranolol reduced FEV1 and the bronchodilating effect of formoterol. Both metoprolol and propranolol increased AHR. Thus, different classes of beta-blockers have different pulmonary effects. The anticipated beneficial cardiovascular effects of a P-blocker must be weighted against the putative detrimental pulmonary effects, ie, effect on FEV1 AHR, and response to additional beta(2)-agonists.
|Number of pages||7|
|Publication status||Published - Mar-2005|
- airway hyperresponsiveness
- OBSTRUCTIVE PULMONARY-DISEASE
- AIR-FLOW OBSTRUCTION
- WORKING PARTY STANDARDIZATION
- EUROPEAN RESPIRATORY SOCIETY
- SEVERE BRONCHOCONSTRICTION
- OFFICIAL STATEMENT