@article {Lipworth880, author = {Brian Lipworth and Jadwiga Wedzicha and Graham Devereux and J{\o}rgen Vestbo and Mark T. Dransfield}, title = {Beta-blockers in COPD: time for reappraisal}, volume = {48}, number = {3}, pages = {880--888}, year = {2016}, doi = {10.1183/13993003.01847-2015}, publisher = {European Respiratory Society}, abstract = {The combined effects on the heart of smoking and hypoxaemia may contribute to an increased cardiovascular burden in chronic obstructive pulmonary disease (COPD). The use of beta-blockers in COPD has been proposed because of their known cardioprotective 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 underused due to concerns regarding potential bronchoconstriction, even with cardioselective drugs. Initiating treatment with beta-blockers requires dose titration and monitoring over a period of weeks, and beta-blockers may be less well tolerated in older patients 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 in mortality and exacerbations conferred by beta-blockers in COPD. However, this requires confirmation from long-term prospective placebo-controlled randomised 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.Beta-blockers are used for heart failure and myocardial infarction but remain underused in COPD despite guidelines http://ow.ly/gbvY301wCUA}, issn = {0903-1936}, URL = {https://erj.ersjournals.com/content/48/3/880}, eprint = {https://erj.ersjournals.com/content/48/3/880.full.pdf}, journal = {European Respiratory Journal} }