Evaluation of the protective effects of β-blockers in the management of acute exacerbations of chronic obstructive pulmonary disease.

WHAT IS KNOWN AND OBJECTIVE: The purpose of this study was to evaluate the association between early β-blocker continuation and major inpatient events in patients hospitalized for an acute exacerbation of chronic obstructive pulmonary disease (AECOPD).

METHODS: This single centre, retrospective, investigational review board approved cohort study evaluated patients admitted for a primary diagnosis of AECOPD. Patients were evaluated based on early continuation of a β-blocker whether a β-blocker was initiated within 24 hours of admission and continued for at least 72 hours. Patients with AECOPD who did not receive β-blockers were assigned to the control group. Major inpatient events were a composite outcome composed of arrhythmias, myocardial infarction (MI) and death. Safety data were collected on the incidences of bradycardia, bronchospasms and hypotension.

RESULTS AND DISCUSSION: Of the 96 patients admitted for AECOPD, fifty-five patients were included in the early β-blocker group and forty-one patients in the control group. Early β-blocker utilization was associated with a significantly lower rate of major inpatient events compared with the control group (40% vs 80.5%; P < 0.001). Arrhythmias were significantly less common in the early β-blocker group (30.9% vs 65.9%; P = 0.001); however, there were no significant differences in the rates of MI (9.1% vs 14.6%; P = 0.54), death (0 vs 0) or safety outcomes between groups.

WHAT IS NEW AND CONCLUSION: β-blocker therapy could result in a paradigm shift in managing chronic obstructive pulmonary disease patients from a true cardiopulmonary approach. This retrospective cohort study demonstrated early β-blocker continuation in patients admitted for an AECOPD was associated with less major inpatient events, primarily arrhythmias.