β-Blockers May Be Beneficial in Pulmonary Disease
Chronic obstructive pulmonary disease patients using intensified dosage of β-blockers show lower mortality after major vascular surgery
WEDNESDAY, Oct. 1 (HealthDay News) -- The use of cardioselective β-blockers in patients with chronic obstructive pulmonary disease (COPD) undergoing vascular surgery appears to be beneficial, according to research published in the Oct. 1 issue of the American Journal of Respiratory and Critical Care Medicine.
Yvette R.B.M. van Gestel, of Erasmus Medical Center in Rotterdam, the Netherlands, and colleagues analyzed data from 3,371 patients who underwent major vascular surgery, including abdominal aortic surgery, carotid endarterectomy and lower limb arterial reconstruction. Thirty-nine percent of patients had COPD based on spirometry and history, and 35 percent of them received cardioselective β-blockers, most commonly bisoprolol and metoprolol.
In patients with COPD, the use of these agents was associated with lower 30-day mortality (odds ratio, 0.37) and long-term mortality (hazard ratio, 0.73), the researchers report. This effect on 30-day mortality was seen with an intensified dose -- defined as an average dose of at least 25 percent of the maximum recommended therapeutic dose -- rather than a low dose. As a result, these drugs should not be withheld from patients with COPD undergoing vascular surgery, the authors write.
"There are currently no prospective long-term data on the safety of β-blockers in COPD. Therefore, although β-blockers can be introduced in any medical setting, it still seems appropriate to use cardioselective β-blockers in patients with COPD at the lowest dose and to titrate slowly with attention to lung function and symptoms," conclude the authors of an accompanying editorial.
The authors of the editorial disclosed a number of financial relationships with pharmaceutical companies.