Beta-Blockers Do Not Appear to Increase Risk of Respiratory Events in Patients With CHF and COPD

Peggy Peck

October 26, 2004

Oct. 26, 2004 (Seattle) -- Physicians are often reluctant to use beta-blockers in patients whose congestive heart failure (CHF) is complicated by chronic obstructive pulmonary disease (COPD), but that caution is misplaced, according to the results of an 18-month study of the effects of beta-blockers in these patients.

Lead investigator Jay I. Peters, MD, professor of medicine at the University of Texas Health Science Center at San Antonio, discussed the findings at a press conference presented at CHEST 2004, the 70th annual meeting of the American College of Chest Physicians. The study will be presented in a poster on Oct. 27.

Dr. Peters said the take-home message is that "physicians should feel more comfortable using beta-blockers, especially cardioselective beta-blockers, in patients with obstructive lung disease. If patients are going to have cardiac surgery or -- as is the case in this study -- if patients have CHF, the benefit far outweighs the risk."

The finding comes from a post-hoc subgroup analysis of a 1,067-patient study that examined the effect of disease management on outcome in CHF. Of the overall population, 5.9% of the patients had asthma, 11.2% had COPD, and 2.5% had both COPD and asthma. Dr. Peters and colleagues studied this subset of 209 patients, checking medical records for every nonroutine physician visit, emergency department visit, and hospitalization over a period of 18 months. In this subset, 38.7% of the patients were taking beta-blockers during the 18 months studied.

Eighty-nine of the 209 patients had spirometry, and "of those, 27 had mild disease, 40 had moderate, and the rest had severe disease, so we do have some confirmation that the patients represent a good spectrum of disease," Dr. Peters said.

Although the study results showed that patients with COPD and asthma were three times more likely to have respiratory events, "when we [looked at] those patients with COPD or asthma who were taking beta-blockers, there was no increase in respiratory events -- rather, they had a statistically significant lower rate of respiratory events ( P = .003)."

Beta-blockers have a somewhat controversial history in treatment of CHF, Dr. Peters said, and "in the 1960s the general belief was that beta-blockers were contraindicated in these patients. This changed with the development of cardioselective beta-blockers that were found to be useful in CHF." But review articles continue to "list asthma and COPD as relative contraindications, which is enough to discourage many physicians from using them," he told Medscape.

Yet, there are almost no data to support this "relative contraindication." A meta-analysis of the use of cardioselective beta-blockers in patients with COPD found that only 10 small studies addressed this issue (n = 141), and the duration of treatment in those studies was only three days to four weeks. Moreover, only 46 of the 141 patients had COPD confirmed with pulmonary function tests.

But Ronald F. Grossman, MD, professor of medicine at the University of Toronto in Ontario Canada, told Medscape that it is too soon to make a blanket recommendation about the use of beta-blockers in these patients.

"These results are interesting, but they are from a retrospective study. So I think it that while they are of interest, a prospective study is needed. I would support funding for such a study and would encourage such a study," Dr. Grossman said. He was not involved in the research by Dr. Peters and colleagues, but he moderated the press conference at which Dr. Peters discussed the results.

The study was funded by the U.S. Department of Defense.

CHEST 2004: Poster 307. Presented Oct. 27, 2004.

Reviewed by Gary D. Vogin, MD


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