Detrimental effects of beta-blockers in COPD - A concern for nonselective beta-blockers

HJ van der Woude*, J Zaagsma, DS Postma, TH Winter, M van Hulst, R Aalbers

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

132 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)818-824
Number of pages7
JournalChest
Volume127
Issue number3
Publication statusPublished - Mar-2005

Keywords

  • airway hyperresponsiveness
  • beta-blockers
  • COPD
  • OBSTRUCTIVE PULMONARY-DISEASE
  • AIR-FLOW OBSTRUCTION
  • WORKING PARTY STANDARDIZATION
  • EUROPEAN RESPIRATORY SOCIETY
  • LUNG-FUNCTION
  • SEVERE BRONCHOCONSTRICTION
  • OFFICIAL STATEMENT
  • CHRONIC-BRONCHITIS
  • METHACHOLINE
  • RESPONSIVENESS

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