Beta blockers have been shown to significantly reduce mortality in ischemic heart disease and CHF, yet are often avoided in patients with obstructive lung disease (OLD). We evaluated the prevalence of beta blocker use in patients with COPD and/or asthma and determined if respiratory events were more common in this subset of patients.
Retrospective analysis of prospectively collected data from 1067 patients with CHF followed over 18 months. Medications, non-routine office visits, ER visits, and hospitalizations for respiratory events were compared.
In patients with CHF, 19.6% (209/1067)had OLD: 5.9% asthma, 11.2% COPD and 2.5% asthma/COPD. Only 35.9% of patients were on beta blockers. Cardioselective beta blockers were used in only 49% of patients with OLD on beta blockers. Patients with OLD had a 3 fold increase in respiratory encounters compared to patients with CHF alone. The use of beta blockers did not result in increased respiratory events. The rate of acute respiratory events (beta blocker vs. no beta blocker) in COPD was 1.13 vs. 1.44 events/yr (p=.42) and 1.20 vs. 1.40 events/yr (p=.57) in asthma. Patients with COPD and asthma (n=27) had a lower rate of acute respiratory events on beta blockers (.56 vs. 2.03 events/yr). Use of beta blockers was not associated with an increase in respiratory encounters, E.R. visits, or hospitalizations. The rates of respiratory events are shown below.
Our study found that the long term use of beta blocking medication did not increase the risk of respiratory complications. We did not see any differences in outcomes with the use of cardioselective vs. noncardioselective agents.
The proven mortality benefit of beta blockers after MI and in CHF mandates their use in patients with OLD whenever possible. Although our study was unable to show significant differences between different classes of beta blockers, cardioselective beta blockers without intrinsic sympathomimetic activity are preferred until future studies resolve this issue.
J.I. Peters, None.