New research has found that beta-blockers significantly reduce mortality in COPD patients. These findings are contrary to the belief that COPD patients should not receive beta-blockers before surgery because of concerns that the drugs will aggravate bronchospasm and worsen airway obstruction.
“Patients with COPD frequently have unrecognized, atherosclerotic disease. This is also a major cause for late morbidity and mortality,” says principle investigator Don Poldermans, MD, PhD, of the Erasmus Medical Center in Rotterdam, the Netherlands.
This study was the first to directly examine the effects of beta-blockers on surgical patients with COPD.
The researchers evaluated the mortality outcomes of more than 3,000 consecutive patients who underwent vascular surgery at the Erasmus Medical Center in Rotterdam between 1990 and 2006. They specifically looked at the effect of a low dose of beta-blockers (less than 25 % maximum recommended therapeutic dose) versus an “intensified” dosage (more than 25 % maximum recommended therapeutic dose).
Thirty-one percent of those evaluated received cardio-selective beta-blockers at their initial hospitalization. There was no apparent clinical difference between the patients with COPD and those without in terms of the likelihood of them receiving beta-blockers.
In the 30 days after surgery, COPD patients that did not receive beta-blockers were twice as likely to die as those who did. During the follow-up period, 40% of COPD patients on beta-blockers died, whereas 67 % who were not on beta-blockers died.
“What was observed in the population, beta-blockers, especially cardioselective beta-blockers like bisoprolol, are well tolerated by COPD patients without inducing respiratory adverse effects. More importantly, they improve outcome, by preventing late cardiac events, a major cause for late morbidity and mortality,” says Poldermans.
“The jury remains out regarding the utility of preoperative beta-blockers for all patients at risk of cardiovascular complications from noncardiac surgery. But this study suggests that carefully selected patients with COPD, which is an extreme risk factor for cardiovascular disease, at best may benefit but at least appear to tolerate cardioselective beta-blocker therapy,” says John E. Heffner MD, past president of the American Thoracic Society.
The results were published in the American Journal of Respiratory and Critical Care Medicine.