Written by Vivian Lei
Patients with cardiovascular disease and concomitant COPD can be safely treated with a combination long-acting beta-agonist and a long-acting muscarinic antagonist when on a baseline beta-blocker.
Why does this matter?
Some physicians may still hesitate to give beta-blockers to patients with COPD, despite the numerous proven benefits of beta-blockers in cardiovascular disease and evidence that supports their safety and lack of detrimental effects on pulmonary function.
You say tomato. I say TONADO.
Researchers conducting the large TONADO study on use of tiotropium/olodaterol in moderate to severe COPD performed a post-hoc cohort analysis of patients who were also on beta-blockers for the length of the study. They looked at lung function, quality of life, and frequency of COPD exacerbations. Of 5,162 patients, 557 were on beta-blockers. There was a similar improvement in lung function at 24 and 52 weeks as measured by trough FEV1 responses and FVC responses. Patients had slightly improved quality of life indices in the beta-blocker group at 24 weeks although this became insignificant at 52 weeks based on the St. George’s Respiratory Questionnaire. There was no significant difference in frequency of COPD exacerbations or time to first COPD exacerbation. Measures of safety and adverse events were similar in both groups.
The results are limited by several factors, including patients having less severe COPD and a higher mean baseline postbronchodilator FEV1 in the β-blocker group. Patients in the beta-blocker group were also more likely to be on lipid-modifying drugs, ACE-inhibitors, and angiotensin II antagonists. Since this was a post-hoc analysis, the study was not specifically designed to test for the effect of beta-blocker use on outcome measures and excluded patients with significant cardiac disease. However, several studies over the past 15 years support beta-blocker use for patients with comorbid cardiovascular disease and COPD. Hopefully, this is just more evidence to put this myth to rest.
β-Blockers in COPD: A Cohort Study From the TONADO Research Program. Chest. 2018 Jun;153(6):1315-1325. doi: 10.1016/j.chest.2018.01.008. Epub 2018 Jan 31.
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Reviewed by Thomas Davis