Huang YL, et al. - This study focused on the impacts of selective and nonselective beta-blocker treatment in patients with COPD. Findings reported that for patients with COPD and cardiovascular disease (CVD), selective beta-blockers can be prescribed with caution but, for COPD patients, nonselective beta-blockers should not be prescribed. For COPD patients, labetalol and propranolol should be avoided, however, betaxolol may be preferred.

Methods

• Using the Taiwan National Health Insurance Research Database, researchers performed this nested case–control study.
• Study participants were COPD patients who used inhalation steroid and beta-blockers between 1998 and 2010.
• From this cohort, there were 16,067 patients with severe exacerbations included in the analysis and 55,970 controls matched on age, sex, COPD diagnosis year, and beta-blockers treatment duration by risk set sampling.

Results

• Data showed that for the selective beta-blocker users, a lower risk of severe exacerbations was reported in the current users vs. the nonusers (odds ratio [OR], 0.90; 95% confidence interval [CI], 0.85–0.96).
• In contrast, it was noted that for the nonselective beta-blocker users, the current users vs. the nonusers had a higher risk of severe acute exacerbations (OR, 1.21; 95% CI, 1.14–1.27).
• Findings demonstrated that in nonselective beta-blockers but not in selective beta-blockers, a higher risk of severe exacerbation during increasing mean daily dose or within about the initial 300 days was observed.
• Researchers also observed that one selective beta-blocker, betaxolol, had a significantly lower risk of severe exacerbations (OR, 0.75; 95% CI, 0.60–0.95).
• In addition, an association was shown, of 2 nonselective beta-blockers (labetalol and propranolol) with a significantly higher risk of exacerbations (OR, 1.49; 95% CI, 1.32–1.67 for labetalol; OR, 1.16; 95% CI, 1.10–1.23 for propranolol).