Effect of β blockers in treatment of chronic obstructive pulmonary disease: a retrospective cohort study
BMJ 2011; 342 doi: https://doi.org/10.1136/bmj.d2549 (Published 10 May 2011) Cite this as: BMJ 2011;342:d2549
- Philip M Short, clinical research fellow respiratory medicine1,
- Samuel I W Lipworth, medical student2,
- Douglas H J Elder, clinical research fellow cardiovascular medicine3,
- Stuart Schembri, consultant respiratory physician4,
- Brian J Lipworth, professor of respiratory medicine1
- 1Asthma and Allergy Research Group, Centre for Cardiovascular and Lung Biology, Division of Medical Sciences, University of Dundee, Dundee DD1 9SY, Scotland, UK
- 2Bute Medical School, University of St Andrews, St Andrews KY16 9UY, Scotland
- 3Centre for Cardiovascular and Lung Biology, Division of Medical Sciences University of Dundee
- 4Department of Respiratory Medicine, Perth Royal Infirmary, Perth PH1 1NX, Scotland
- Correspondence to: B J Lipworth brianlipworth{at}gmail.com
- Accepted 8 March 2011
Abstract
Objective To examine the effect of β blockers in the management of chronic obstructive pulmonary disease (COPD), assessing their effect on mortality, hospital admissions, and exacerbations of COPD when added to established treatment for COPD.
Design Retrospective cohort study using a disease specific database of COPD patients (TARDIS) linked to the Scottish morbidity records of acute hospital admissions, the Tayside community pharmacy prescription records, and the General Register Office for Scotland death registry.
Setting Tayside, Scotland (2001–2010)
Population 5977 patients aged >50 years with a diagnosis of COPD.
Main outcome measures Hazard ratios for all cause mortality, emergency oral corticosteroid use, and respiratory related hospital admissions calculated through Cox proportional hazard regression after correction for influential covariates.
Results Mean follow-up was 4.35 years, mean age at diagnosis was 69.1 years, and 88% of β blockers used were cardioselective. There was a 22% overall reduction in all cause mortality with β blocker use. Furthermore, there were additive benefits of β blockers on all cause mortality at all treatment steps for COPD. Compared with controls (given only inhaled therapy with either short acting β agonists or short acting antimuscarinics), the adjusted hazard ratio for all cause mortality was 0.28 (95% CI 0.21 to 0.39) for treatment with inhaled corticosteroid, long acting β agonist, and long acting antimuscarinic plus β blocker versus 0.43 (0.38 to 0.48) without β blocker. There were similar trends showing additive benefits of β blockers in reducing oral corticosteroid use and hospital admissions due to respiratory disease. β blockers had no deleterious impact on lung function at all treatment steps when given in conjunction with either a long acting β agonist or antimuscarinic agent
Conclusions β blockers may reduce mortality and COPD exacerbations when added to established inhaled stepwise therapy for COPD, independently of overt cardiovascular disease and cardiac drugs, and without adverse effects on pulmonary function.
Footnotes
We thank Peter Donnan, professor of epidemiology and biostatistics, University of Dundee, for his advice and support.
Contributors: All authors contributed to the study design and data interpretation. PMS, SIWL, and DHJE undertook the data analysis and validation. PMS and BJL wrote the first draft of the manuscript, and all authors contributed to the final draft. BJL is guarantor for the study. Data were collated and provided to the authors by the Health Informatics Centre (a partnership between the University of Dundee, NHS Tayside, and the Information Services Division of NHS National Services Scotland).
Funding: This study was funded by the University of Dundee. The university had no influence over the design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation, review, or approval of the manuscript.
Competing interests: All authors have completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous 3 years; no other relationships or activities that could appear to have influenced the submitted work.
Ethical approval: The study was approved by the Tayside Medical Research Ethics Committee.
Data sharing: No additional data available.
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