Correspondence |
Safety of beta-blockers in COPD: the jury must still be out
Sir,Egred and colleagues1 encourage the use of beta-blockers in patients with acute coronary syndrome (ACS) and concomitant chronic obstructive pulmonary disease (COPD). Their retrospective analysis highlights the discordance in practice that exists between cardiologist and pulmonologist. Indeed, the former is keen to commence beta-blockers in patients with ACS for cardioprotection, while the latter is cautious in protecting patients with obstructive airway disease from bronchoconstriction.
There are currently no prospective long-term data on the safety of beta-blockers in COPD, and moreover, beta-blockers are contraindicated in asthma. As shown by the authors, it is not always easy to differentiate between asthma and COPD, especially when inhaled therapy for both conditions is very similar. It is also vital to stress that reversibility testing has been largely abandoned in the diagnosis of COPD, unless diagnostic difficulty is encountered.2
Recent data3 suggest that non-selective beta-blockers are detrimental to patients with COPD. For instance, propranolol has been shown to worsen lung function and desensitize the airway to the bronchodilating effects of long-acting beta2-agonists, while metoprolol, which has been advocated by the authors to be safe in COPD due to its cardioselectivity, significantly increased the extent of bronchial hyper-responsiveness.
Until data from long-term studies that specifically address these safety issues are available, the jury must still be out in deciding whether any beta-blockers are safe in COPD.
Department of Respiratory Medicine Ipswich Hospital Ipswich Department of Respiratory Medicine Aberdeen Royal Infirmary Aberdeen email: dkclee{at}doctors.org.uk
References
1. Egred M, Shaw S, Mohammad B, Waitt P, Rodrigues E. Under-use of beta-blockers in patients with ischaemic heart disease and concomitant chronic obstructive pulmonary disease. Q J Med 2005; 98:493–7.
2. The British Thoracic Society and Scottish Intercollegiate Guidelines Network 2004 update to the British guideline on the management of asthma. [http://www.brit-thoracic.org.uk/docs/asthmafull.pdf]
3. van der Woude HJ, Zaagsma J, Postma DS, Winter TH, van Hulst M, Aalbers R. Detrimental effects of beta-blockers in COPD: a concern for nonselective beta-blockers. Chest 2005; 127:818–24.
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