WebMD Medical News
Laura J. Martin, MD
May 24, 2010 -- Beta-blocker medications, which are not commonly prescribed for patients with chronic lung disease, may actually be of benefit to them, according to a new study.
The medications, prescribed for high blood pressure and cardiac disorders, may help lengthen survival and reduce respiratory flare-ups, according to a team of Dutch researchers.
In years past, doctors have hesitated to give beta-blockers to these patients with chronic obstructive pulmonary disease (COPD) because of concerns that the drugs might have adverse effects on the lungs.
The new study suggests otherwise. ''Our study is the first that clearly gives a hint that beta-blockers could also exert a pulmonary beneficial effect as shown by their reduction of exacerbations," says study researcher Frans Rutten, MD, PhD, an assistant professor of medicine at the Julius Center for Health Sciences and Primary Care at the University Medical Center Utrecht, Netherlands.
The study is published in the Archives of Internal Medicine.
Research in 2002 showed that beta-blockers that are cardioselective (preferentially affecting the heart, not other body systems) are well-tolerated in those patients with COPD, says Rutten.
Other research showed that patients with heart failure plus COPD and those with COPD who had suffered heart attacks did well on beta-blockers, too, Rutten says.
In the new study, Rutten and his colleagues looked at 2,230 men and women, age 45 and older, who had gotten a diagnosis of COPD between 1996 and 2006. COPD includes emphysema, chronic bronchitis, or both. About 16 million Americans have COPD, according to the National Lung Health Education Program. COPD is mainly caused by smoking.
Those with COPD are also prone to develop cardiovascular disease and often need medications to treat both the cardiovascular disease and the lung disease. Examples of beta-blockers are atenolol (Tenormin), metprolol (Lopressor, Toprol-XL), and carvedilol (Coreg).
In the study, nearly 30% were on beta-blockers while others were on different kinds of cardiovascular drugs, sometimes in combination.
During the 7.2-year average follow-up, 686 patients, or about 31%, died, and 47.3% or 1,055, had at least one episode of worsening of COPD.
Those who took a beta-blocker were 32% less likely to die during the study follow-up and 39% less likely to have worsening of COPD than those who didn't use the drugs.
Ideally, Rutten says, the next step is to compare beta-blockers with placebo in patients with COPD, both with and without co-existing cardiovascular disease and high blood pressure, to confirm the results.
The new study results may change practice, according to two doctors familiar with the study.
"This is a very important study." Says Don Sin, MD, MPH, a professor of medicine and a lung specialist at the University of British Columbia and the Providence Heart and Lung Institute in Vancouver, who wrote an editorial to accompany the study.
'It appears that individuals with COPD who took the beta-blockers had better outcomes than those who did not," he tells WebMD.
The study, he writes in his editorial, "has turned the story of beta-blockers in COPD into a curious case of a foe becoming a potential friend to millions of patients with COPD worldwide."
"For years, people have automatically assumed that beta-blockers were unhealthy for asthmatic and COPD patients," he says. He cautioned, however, that the study did not look at those with asthma, so that needs further study.
''Before this study, it would have been completely acceptable to not consider beta-blockers in patients with COPD," says Anthony Gerber, MD, PhD, assistant professor of medicine at National Jewish Health in Denver, who reviewed the study and editorial for WebMD.
But now, he says, the message for doctors caring for COPD patients who also have coexisting cardiovascular disease is that a doctor should not automatically rule out beta-blockers in COPD patients.
Doctors can try a beta-blocker and monitor a COPD patient's lung function to see if the lung function is compromised with the medication, and then decide what to do accordingly, he says.
SOURCES:Rutten, F. Archives of Internal Medicine, May 24, 2010; vol 170: pp 880-887.Sin, D. Archives of Internal Medicine, May 24, 2010; vol 170: pp 849-850.Frans Rutten, MD, PhD, assistant professor of medicine, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Netherlands.Don Sin, MD, MPH, professor of medicine, University of British Columbia and Providence Heart and Lung Institute, Vancouver, Canada.Anthony Gerber, MD, PhD, assistant professor of medicine, National Jewish Health, Denver.National Lung Health Education Program.
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