Multicentric study on the beta-blocker use and relation with exacerbations in COPD

• DOI: 10.1016/j.rmed.2014.02.009
• Publication Date: 2014-02-20T17:30:18Z
• Authors: Luis Puente-Maestu; Myriam Calle; Ángel Ortega-Gonz...; Antonia Fuster; Cruz González; Eduardo Márquez-M...; Pedro Jorge Marco...; Carmen Calero; Juan Luis Rodrígu...; Rosa Malo de Molina; Myriam Aburto; Patricia Sobradillo; Bernardino Alcázar; Gema Tirado-Conde
• Keywords: Pulmonary and Respiratory Medicine; Male; Adrenergic beta-Antagonists; Heart failure; Comorbidity; Coronary Artery Disease; Emergency treatment; Severity of Illness Index; Pulmonary Disease, Chronic Obstructive; 03 medical and health sciences; 0302 clinical medicine; Risk Factors; Adrenergic beta-antagonists; Humans; Aged; Aged, 80 and over; Heart Failure; Adverse effects; Chronic obstructive pulmonary disease; Middle Aged; Drug Utilization; Bronchodilator Agents; 3. Good health; Myocardial infarction; Cross-Sectional Studies; Spain; Female; Emergency Service, Hospital

Chronic obstructive pulmonary disease (COPD) is frequently associated with chronic heart failure (CHF) or coronary artery disease (CAD). In spite of the recommendation to use beta-blockers (BB) they are likely under-prescribed to patients with concurrent COPD and heart diseases. To find out the prevalence of use of BB, 256 COPD patients were consecutively recruited by pulmonary physicians from 14 hospitals in 7 regions of Spain in their outpatient offices if they had a diagnosis of COPD, were not on long-term oxygen therapy, had CHF or CAD, and met the criteria for BB treatment. In patients with indication 58% (95%CI, 52-64%) of the COPD patients and 97% of the non-COPD patients were on BB (p < 0.001). In patients with COPD, several factors were independently related to at least one visit to the emergency room in the previous year such as use of BB, adjusted OR = 0.27 (95% CI 0.15-0.50), GOLD stage D, OR = 2.52 (1.40-4.53), baseline heart rate >70, OR 2.19 (1.24-3.86) use of long-acting beta2-agonists OR = 2.18 (1.29-3.68), previous episodes of left ventricular failure OR 2.27 (1.19-4.33) and diabetes, OR = 1.82 (1.08-3.38). We conclude that, according to what is recommended by current guidelines, BB are still under-prescribed in COPD patients. COPD patients with CHF or CAD using BB suffer fewer exacerbations and visits to the ER. GOLD stage, use of long-acting beta2-agonists, baseline heart rate and comorbidities are also risk factors for exacerbations in this population.