Beta Blockers May Cut Mortality in COPD Patients After Surgery
Preoperative use was well-tolerated without adverse respiratory effects, study finds
WEDNESDAY, Oct. 1, 2008 (HealthDay News) -- Contrary to previous belief, giving beta blockers before surgery may significantly reduce mortality in people with chronic obstructive pulmonary disease (COPD), a new report says.
Doctors have been hesitant about giving COPD patients beta blockers before surgery, fearing it could aggravate bronchospasm and worsen airway obstruction. Prior clinical trials, even those done on patients undergoing noncardiac surgery, had yielded inconsistent results.
This new Netherlands study, done over 10 years on more than 3,000 patients with COPD having vascular surgery, found that those who did not receive beta blockers were twice as likely to die within a month of surgery as those who did (8 percent versus 4 percent). During a follow-up period, 40 percent of COPD patients on beta blockers died, whereas 67 percent who were not on beta blockers died.
The findings are published in the first October issue of the American Journal of Respiratory and Critical Care Medicine.
"What was observed in the population, beta blockers, especially cardio-selective beta blockers like bisoprolol, are well-tolerated by COPD patients without inducing respiratory adverse effects. More importantly, they improve outcome, by preventing late cardiac events, a major cause for late morbidity and mortality," principle investigator Dr. Don Poldermans of the Erasmus Medical Center in Rotterdam, said in a news release issued by the journal's publisher.
They also found that an intensified dose (more than 25 percent maximum recommended therapeutic dose) of beta blockers was tied to the reduced 30-day mortality, while a low dose of beta blockers (less than 25 percent maximum recommended therapeutic dose) was not. However, the intensified and low dosages were linked to similar reductions in mortality over the long term.
"The indications of our findings are that a high dose might be preferred in the COPD population," Poldermans said. "The safety of cardio-selective beta blockers in the COPD population will support their use."
Still, some remain skeptical. The new findings contradict another report -- the POISE (Perioperative Ischemic Evaluation) study -- that found higher mortality rates among patients with and without COPD who were treated with preoperative beta blockers.
"The jury remains out regarding the utility of preoperative beta blockers for all patients at risk of cardiovascular complications from noncardiac surgery," John E. Heffner, Garnjobst, chair at Providence Portland Medical Center, said in the publisher's news release. "But this study suggests that carefully selected patients with COPD, which is an extreme risk factor for cardiovascular disease, at best may benefit, but at least appear to tolerate cardio-selective beta blocker therapy."
The National Heart, Lung, and Blood Institute has more about chronic obstructive pulmonary disease.