Cardioselective beta-blockers do not appear to increase the rate of exacerbations in patients with chronic obstructive pulmonary disease (COPD), according to findings from a recently published review.

To investigate this association, the authors searched MEDLINE and EMBASE for studies assessing COPD exacerbation rates in patients on beta-blocker therapy. “A total of 15 articles were included; 7 articles showed no change, 1 provided mixed results, and 7 indicated a significant decrease in COPD exacerbations in a variety of exacerbation severities,” the authors reported. It was noted that only 2 studies included in the analysis differentiated between cardioselective and non-cardioselective beta-blockers.

In their discussion, the authors stated that while the review was limited by the number of studies, the available evidence does indicate that cardioselective beta-blockers do not increase exacerbation rates in patients with COPD, and may even decrease them. “These findings raise the question of whether beta-blockers should be used more frequently in patients with COPD,” they added. Given that their study was only an initial assessment of this relationship, the authors advocated for completing controlled trials to further analyze this association. 

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Currently, the prescribing information for beta-blockers includes a warning about the use of these agents in patients with bronchospastic disease.  In general, the labeling states that patients with bronchospastic disease should not receive beta-blockers, and if cardioselective agents are used (in those who do not tolerate other antihypertensive medications), then bronchodilators should be readily available, as beta1-selectivity is not absolute. 

Based on their findings, the study authors concluded that “Given the likelihood for CVD in the COPD population, these agents should not be withheld for concurrent cardiovascular conditions, especially where mortality benefit (eg, systolic HF, recent MI) has been established.”

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