Annals of the American Thoracic Society: Published on October, 2022

Chronic obstructive pulmonary disease (COPD) is a leading cause of death worldwide [1, 2]. COPD exacerbations that are related to poor prognosis and severe COPD exacerbations requiring hospital admission.

Beta-adrenoceptor (β-ADR) antagonists, or “beta blockers,” are indicated for the treatment of heart failure, hypertension, and ischaemic heart disease, all of which are more common in patients with COPD. 

There was a historic concern over prescribing beta-blocker therapy in patients with COPD due to the fear of increased exacerbation frequency, as exacerbations of COPD are associated with increased mortality and lung function decline.

Cardioselective beta blockers are well-tolerated in patients with moderate to severe COPD, demonstrating no negative impact on pulmonary function, objective measures of dyspnea, and 6-minute walk distance.

This study evaluated the change in lung function (FEV₁ and FVC) and chronic obstructive pulmonary disease (COPD) exacerbations in patients using less cardioselective beta blockers metoprolol versus placebo.

TAKE-HOME MESSAGE

While metoprolol did not yield promising results in reducing exacerbations, Authors reinforced the evidence that metoprolol was well-tolerated in terms of pulmonary function.

This study found decreases in FEV₁ and FVC values in the metoprolol group early during treatment; it did not find other clear associations between more severe exacerbations and metoprolol use.

Furthermore, this study demonstrated that FVC bronchodilator responsiveness, independent of metoprolol use, was associated with a higher rate of severe COPD exacerbations.

This study supports the idea that COPD is a heterogeneous disease, and some phenotypes are more prone to severe exacerbations (regardless of metoprolol or other medication use).

Conclusions: Metoprolol was associated with reduced lung function during the early part of the treatment period, but these effects were modest and did not persist.

Early lung function reduction and baseline bronchodilator responsiveness did not interact with the treatment arm to predict exacerbations; however, baseline FVC bronchodilator responsiveness was associated with a 60% higher rate of severe or very severe exacerbations.

Doctors Liked to Read More