Chest
Clinical Investigations: COPDDetrimental Effects of β-Blockers in COPD: A Concern for Nonselective β-Blockers
Section snippets
Materials and Methods
Patients with stable mild-to-moderate COPD participated in the study.4 Inclusion criteria were as follows: age 40 to 70 years, FEV1 ≥ 1.5 L and from 60 to 80% predicted,12 FEV1/FVC ≤ 0.7, pulse rate ≥ 60 beats/min, ≥ 15 pack-years smoking history, and reversibility ≤ 12% of predicted FEV1 after inhalation of 400 μg salbutamol. Major exclusion criteria were a history of asthma, the use of β-blocking agents, and the presence of significant diseases other than COPD, which could have put the
Results
Between April 2001 and February 2002, 35 patients were recruited from our outpatient clinic. Twenty patients failed to fulfil all inclusion and exclusion criteria. Reasons for not entering the study were FEV1 out of range (n = 13), no methacholine threshold (n = 2), heart rate too slow (n = 1), reversibility (n = 1), and administrative reasons (n = 3)
The remaining 15 patients were randomized, and all completed the study. The compliance rate was 100%. Treatments were well tolerated, although
Discussion
In this study, we found evidence of the negative effects of β-blocker treatment on lung function (FEV1) and AHR in patients with mild-to-moderate, irreversible COPD. FEV1 deteriorated significantly during 4 days of propranolol treatment only, whereas AHR deteriorated both during propranolol and metoprolol treatment when compared to placebo.
In addition, the fast bronchodilating effect of the β2-adrenergic agonist formoterol was significantly impaired after propranolol treatment, but unaffected
Acknowledgments
We thank G. D. Nossent, I. P. Smit, E. F. Smit, L. H. Steenhuis, C. G. Tol, and S. H. Wills for their contribution for the clinical part of the study; and M. Boorsma and P. Gobbens for assistance with data analysis.
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This work was sponsored by an unconditional grant from AstraZeneca