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β-Blockers are associated with a reduction in COPD exacerbations
  1. Surya P Bhatt1,
  2. James M Wells1,
  3. Gregory L Kinney2,
  4. George R Washko Jr3,
  5. Matthew Budoff4,
  6. Young-il Kim5,
  7. William C Bailey1,
  8. Hrudaya Nath6,
  9. John E Hokanson2,
  10. Edwin K Silverman7,
  11. James Crapo8,
  12. Mark T Dransfield1,9
  13. For the COPDGene Investigators
  1. 1Division of Pulmonary, Allergy and Critical Care Medicine, UAB Lung Health Center, University of Alabama at Birmingham, Birmingham, Alabama, USA
  2. 2Department of Epidemiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
  3. 3Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
  4. 4Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California, USA
  5. 5Department of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
  6. 6Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
  7. 7Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
  8. 8Division of Pulmonary and Critical Care, National Jewish Health, Denver, Colorado, USA
  9. 9Birmingham VA Medical Center, Birmingham, Alabama, USA
  1. Correspondence to Dr Surya P Bhatt, University of Alabama at Birmingham, Division of Pulmonary, Allergy and Critical Care Medicine, THT 422, 1720, 2nd Avenue South, Birmingham, AL 35294, USA; spbhatt{at}uab.edu

Abstract

Background While some retrospective studies have suggested that β-blocker use in patients with COPD is associated with a reduction in the frequency of acute exacerbations and lower mortality, there is concern that their use in patients with severe COPD on home oxygen may be harmful.

Methods Subjects with Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage 2–4 COPD participating in a prospective follow-up of the COPDGene cohort, a multicentre observational cohort of current and former smokers were recruited. Total and severe exacerbation rates were compared between groups categorised by β-blocker use on longitudinal follow-up using negative binomial regression analyses, after adjustment for demographics, airflow obstruction, %emphysema on CT, respiratory medications, presence of coronary artery disease, congestive heart failure and coronary artery calcification, and after adjustment for propensity to prescribe β-blockers.

Results 3464 subjects were included. During a median of 2.1 years of follow-up, β-blocker use was associated with a significantly lower rate of total (incidence risk ratio (IRR) 0.73, 95% CI 0.60 to 0.90; p=0.003) and severe exacerbations (IRR 0.67, 95% CI 0.48 to 0.93; p=0.016). In those with GOLD stage 3 and 4 and on home oxygen, use of β-blockers was again associated with a reduction in the rate of total (IRR 0.33, 95% CI 0.19 to 0.58; p<0.001) and severe exacerbations (IRR 0.35, 95% CI 0.16 to 0.76; p=0.008). Exacerbation reduction was greatest in GOLD stage B. There was no difference in all-cause mortality with β-blocker use.

Conclusions β-Blockers are associated with a significant reduction in COPD exacerbations regardless of severity of airflow obstruction. The findings of this study should be tested in a randomised, placebo-controlled trial.

Trial registration number (ClinicalTrials.gov NCT00608764).

  • COPD Exacerbations

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