The value of beta blockers in patients with chronic obstructive pulmonary disease_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

 DU Fei , ZHANG Longju , CHEN Daigang , YANG Huajun

Department of Respiratory Medicine, The First People’s Hospital of Zunyi, Institute of Respiratory Diseases, Zunyi, Guizhou 563000, P. R. China;

Corresponding author：

DU Fei, Email: fei632@163.com

Keywords：

Chronic obstructive pulmonary disease; Acute exacerbation; Beta blockers; Cardiovascular diseases; Comorbidity

DOI：

10.7507/1671-6205.201807010

Video：

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Objectives To explore the safety and efficacy of beta-blockers (BBs) in patients with chronic obstructive pulmonary disease (COPD) and its effect on prognosis. Methods The data of 366 patients with acute exacerbation of COPD in this department were analyzed retrospectively. The use rate and related events of BBs were evaluated, including comorbidity, indications, contraindications and related clinical indicators. Results Of the 366 patients, 156 (42.6%) had at least one indication of the use of BBs, but only 53 (34.0%) of these patients used BBs, and 61 patients (39.1%) had no contraindications but did not use BBs. At admission, 72 patients (19.7%) were treated with BBs, 177 (45.6%) with antiplatelet drugs, 145 (39.6%) with statins, and angiotensin converting enzyme inhibitor/angiotensin II receptor blocker was used in 168 (45.9%) patients. Twenty-five patients (6.8%) had ischemic heart disease during hospitalization. Fifty-seven patients (15.6%) had cardiovascular and cerebrovascular events during admission. The patients with cardiovascular and cerebrovascular events had longer hospitalization (P<0.01) and higher in-hospital mortality (P=0.02). Conclusions Patients with COPD have a clear indication of BBs use, but the clinical use rate is still very low. Further research is needed to explore the prescription disorders of BBs in patients with COPD.

Citation： DU Fei, ZHANG Longju, CHEN Daigang, YANG Huajun. The value of beta blockers in patients with chronic obstructive pulmonary disease. Chinese Journal of Respiratory and Critical Care Medicine, 2019, 18(1): 5-9. doi: 10.7507/1671-6205.201807010 Copy

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2.	Groenewegen KH, Schols AM, Wouters EF. Mortality and mortality related factors after hospitalization for acute exacerbation of COPD. Chest, 2003, 124(2): 459-467.
3.	Almagro P, Calbo E, Ochoa de Echagüen A, et al. Mortality after hospitalization for COPD. Chest, 2002, 121(5): 1441-1448.
4.	Soler-Cataluña JJ, Martínez-García MÁ, Román Sánchez P, et al. Severe acute exacerbations and mortality in patients with chronic obstructive pulmonary disease. Thorax, 2005, 60(11): 925-931.
5.	Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for diagnosis, management, and prevention of COPD; 2016. Available from: http://goldcopd.org/global-strategy-diagnosismanagement-prevention-copd-2016/. Accessed January 18, 2016.
6.	杜飞, 张李, 陈代刚, 等. 不同程度的慢性阻塞性肺疾病患者合并心血管疾病及其危险因素的比较. 中国呼吸与危重监护杂志, 2017, 16(4): 311-313.
7.	Smith MC, Wrobel JP. Epidemiology and clinical impact of major comorbidities in patients with COPD. Int J COPD, 2014, 8(9): 871-888.
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10.	Quint JK, Herrett E, Bhaskaran K, et al. Effect of β blockers on mortality after myocardial infarction in adults with COPD: population based cohort study of UK electronic healthcare records. BMJ, 2013, 347: f6650.
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12.	Salpeter SR, Ormiston TM, Salpeter EE. Cardiovascular effects of beta-agonists in patients with asthma and COPD: a meta-analysis. Chest, 2004, 125(6): 2309-2321.
13.	中华医学会呼吸病分会慢性阻塞性肺部疾病学组. 慢性阻塞性肺疾病诊治指南 (2013 年修订版). 中华结核和呼吸杂志, 2013, 36(4): 255-264.
14.	McMurray JJ, Adamopoulos S, Anker SD, et al. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail, 2012, 14(8): 803-869.
15.	Vestbo J, Hurd SS, Agusti AG, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med, 2013, 187(4): 347-365.
16.	Harrison MT, Short P, Williamson PA, et al. Thrombocytosis is associated with increased short and long term mortality after exacerbation of chronic obstructive pulmonary disease: a role for antiplatelet therapy. Thorax, 2014, 69(7): 609-615.
17.	Lipworth B, Skinner D, Devereux G, et al. Underuse of β-blockers in heart failure and chronic obstructive pulmonary disease. Heart, 2016, 102(23): 1909-1914.
18.	Donaldson GC, Hurst JR, Smith CJ, et al. Increased risk of myocardial infarction and stroke following exacerbation of COPD. Chest, 2010, 137(5): 1091-1097.
19.	MacGarvey LP, John M, Anderson JA, et al. Ascertainment of cause-specific mortality in COPD: operations of the TORCH Clinical Endpoint Committee. Thorax, 2007, 62(5): 411-415.
20.	MacDonald MI, Shafuddin E, King PT, et al. Cardiac dysfunction during exacerbations of chronic obstructive pulmonary disease. Lancet Respir Med, 2016, 4(2): 138-148.
21.	Laratta CR, van Eeden S. Acute exacerbation of chronic obstructive pulmonary disease: cardiovascular links. Biomed Res Int, 2014, 2014: 528789.
22.	Du Q, Sun Y, Ding N, et al. Beta-blockers reduced the risk of mortality and exacerbation in patients with COPD: a meta-analysis of observational studies. PLoS One, 2014, 9(11): e113048.
23.	Bhatt SP, Connett JE, Voelker H, et al. β-blockers for the prevention of acute exacerbations of chronic obstructive pulmonary disease (βLOCK COPD): a randomized controlled study protocol. BMJ Open, 2016, 6(6): e012292.
24.	Su VY, Chang YS, Hu YW, et al. Carvedilol, bisoprolol, and metoprolol use in patients with coexistent heart failure and chronic obstructive pulmonary disease. Medicine (Baltimore), 2016, 95(5): e2427.
25.	Jabbour A, Macdonald PS, Keogh M, et al. Differences between betablockers in patients with chronic heart failure and chronic obstructive pulmonary disease: a randomized crossover trial. J Am Coll Cardiol, 2016, 55(17): 1780-1787.

1. World Health Organization Factsheet. Chronic obstructive pulmonary disease (COPD); Fact sheet; November 2016. Available at: http://www.who.int/mediacentre/factsheets/fs315/en/. Accessed March 23, 2017.
2. Groenewegen KH, Schols AM, Wouters EF. Mortality and mortality related factors after hospitalization for acute exacerbation of COPD. Chest, 2003, 124(2): 459-467.
3. Almagro P, Calbo E, Ochoa de Echagüen A, et al. Mortality after hospitalization for COPD. Chest, 2002, 121(5): 1441-1448.
4. Soler-Cataluña JJ, Martínez-García MÁ, Román Sánchez P, et al. Severe acute exacerbations and mortality in patients with chronic obstructive pulmonary disease. Thorax, 2005, 60(11): 925-931.
5. Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for diagnosis, management, and prevention of COPD; 2016. Available from: http://goldcopd.org/global-strategy-diagnosismanagement-prevention-copd-2016/. Accessed January 18, 2016.
6. 杜飞, 张李, 陈代刚, 等. 不同程度的慢性阻塞性肺疾病患者合并心血管疾病及其危险因素的比较. 中国呼吸与危重监护杂志, 2017, 16(4): 311-313.
7. Smith MC, Wrobel JP. Epidemiology and clinical impact of major comorbidities in patients with COPD. Int J COPD, 2014, 8(9): 871-888.
8. Miller J, Edwards LD, Agustí A, et al. Comorbidity, systemic inflammation and outcomes in the ECLIPSE cohort. Respir Med, 2013, 107(9): 1376-1384.
9. Divo M, Cote C, de Torres JP, et al. Comorbidities and risk of mortality in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med, 2012, 186(2): 155-161.
10. Quint JK, Herrett E, Bhaskaran K, et al. Effect of β blockers on mortality after myocardial infarction in adults with COPD: population based cohort study of UK electronic healthcare records. BMJ, 2013, 347: f6650.
11. Short PM, Lipworth SW, Elder DHJ, et al. Effect of β blockers in treatment of chronic obstructive pulmonary disease: a retrospective cohort study. BMJ, 2011, 342: d2549.
12. Salpeter SR, Ormiston TM, Salpeter EE. Cardiovascular effects of beta-agonists in patients with asthma and COPD: a meta-analysis. Chest, 2004, 125(6): 2309-2321.
13. 中华医学会呼吸病分会慢性阻塞性肺部疾病学组. 慢性阻塞性肺疾病诊治指南 (2013 年修订版). 中华结核和呼吸杂志, 2013, 36(4): 255-264.
14. McMurray JJ, Adamopoulos S, Anker SD, et al. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail, 2012, 14(8): 803-869.
15. Vestbo J, Hurd SS, Agusti AG, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med, 2013, 187(4): 347-365.
16. Harrison MT, Short P, Williamson PA, et al. Thrombocytosis is associated with increased short and long term mortality after exacerbation of chronic obstructive pulmonary disease: a role for antiplatelet therapy. Thorax, 2014, 69(7): 609-615.
17. Lipworth B, Skinner D, Devereux G, et al. Underuse of β-blockers in heart failure and chronic obstructive pulmonary disease. Heart, 2016, 102(23): 1909-1914.
18. Donaldson GC, Hurst JR, Smith CJ, et al. Increased risk of myocardial infarction and stroke following exacerbation of COPD. Chest, 2010, 137(5): 1091-1097.
19. MacGarvey LP, John M, Anderson JA, et al. Ascertainment of cause-specific mortality in COPD: operations of the TORCH Clinical Endpoint Committee. Thorax, 2007, 62(5): 411-415.
20. MacDonald MI, Shafuddin E, King PT, et al. Cardiac dysfunction during exacerbations of chronic obstructive pulmonary disease. Lancet Respir Med, 2016, 4(2): 138-148.
21. Laratta CR, van Eeden S. Acute exacerbation of chronic obstructive pulmonary disease: cardiovascular links. Biomed Res Int, 2014, 2014: 528789.
22. Du Q, Sun Y, Ding N, et al. Beta-blockers reduced the risk of mortality and exacerbation in patients with COPD: a meta-analysis of observational studies. PLoS One, 2014, 9(11): e113048.
23. Bhatt SP, Connett JE, Voelker H, et al. β-blockers for the prevention of acute exacerbations of chronic obstructive pulmonary disease (βLOCK COPD): a randomized controlled study protocol. BMJ Open, 2016, 6(6): e012292.
24. Su VY, Chang YS, Hu YW, et al. Carvedilol, bisoprolol, and metoprolol use in patients with coexistent heart failure and chronic obstructive pulmonary disease. Medicine (Baltimore), 2016, 95(5): e2427.
25. Jabbour A, Macdonald PS, Keogh M, et al. Differences between betablockers in patients with chronic heart failure and chronic obstructive pulmonary disease: a randomized crossover trial. J Am Coll Cardiol, 2016, 55(17): 1780-1787.

Chinese Journal of Respiratory and Critical Care Medicine

The value of beta blockers in patients with chronic obstructive pulmonary disease

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