The combined effects on the heart of smoking and hypoxaemia may contribute to an increased cardiovascular burden in COPD. The use of beta-blockers in COPD has been proposed because of their known cardio-protective effects as well as reducing heart rate and improving systolic function. Despite the proven cardiac benefits of beta-blockers post myocardial infarction and in heart failure they remain under used due to concerns regarding potential bronchoconstriction even with cardio-selectivedrugs. Initiating treatment with beta-blockers requires dose titration and monitoring over a period of weeks, and beta-blockers may be less well tolerated in olderpatients with COPD who have other comorbidities. Medium term prospective placebo controlled safety studies in COPD are warranted to reassure prescribers regarding the pulmonary and cardiac tolerability of beta-blockers as well as evaluating their potential interaction with concomitant inhaled long acting bronchodilator therapy.Several retrospective observational studies have shown impressive reductions inmortality and exacerbations conferred by beta-blockers in COPD. However, this requires confirmation from long term prospective placebo controlled randomized controlled trials. The real challenge is to establish whether beta-blockers confer benefits on mortality and exacerbations in all patients with COPD including those with silent cardiovascular disease where the situation is less clear.
- coronary artery disease
- heart failure