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Beta Blockers and COPD: Benefits, Risks and Types

Beta-blockers are medications doctors may recommend for cardiovascular disease, which is common in people with chronic obstructive pulmonary disease (COPD). However, their use is not without controversy.

COPD is a progressive lung disease that makes it difficult to breathe. Some researchers worry that beta-blockers may increase mortality in people with severe COPD who use home oxygen. However, recent studies have not suggested that these drugs carry this risk.

This article reviews beta-blockers and COPD, including what they do, their benefits, risks, and types.

Beta-blockers are drugs that reduce stress on the heart and blood vessels. Doctors prescribe them to manage cardiovascular diseases, such as high blood pressure and angina. They may also prescribe them for anxiety, migraine, tremors, and other conditions.

Beta-blockers work by blocking the action of stress hormones that the body releases during the “fight or flight” response. This includes adrenaline and noradrenaline.

Adrenaline increases heart rate and blood pressure, which can put harmful stress on the heart of people with cardiovascular disease. The fight or flight response also leads to sweating, anxiety, and nervousness.

Beta-blockers slow the heart rate and reduce the force of contraction. They also cause the blood vessels to relax. All of these lead to a drop in blood pressure.

Additionally, beta blockers primarily affect beta 1 receptors in the heart. Blocking these receptors leads to a reduction in heart rate and the force of contraction of the heart muscle. However, these drugs also affect beta 2 receptors in blood vessels and bronchial tubes. Blocking these receptors leads to contraction of smooth muscles, narrowing of the airways and increased blood pressure. There is therefore concern that non-selective beta-blockers may worsen airway obstruction by narrowing the airways.

Yes, in some cases beta-blockers can help with COPD. Indeed, people with the disease often also have problems with their cardiovascular system, due to the effects of factors such as:

  • systemic inflammation
  • genetic susceptibility
  • smoking
  • advanced age

A 2021 review of 23 observational studies and 14 randomized clinical trials have linked the use of beta-blockers to a reduced risk of acute exacerbations of COPD. An acute COPD exacerbation is a sudden increase in symptoms such as coughing, sputum production, and difficulty breathing.

The review also suggested that beta-blockers reduced mortality and improved quality of life. An exception was propranolol, which decreased forced expiratory volume 1, a measure of air exhalation. This suggests that propranolol may reduce lung function.

Beta-blockers may also have useful non-cardiac effects, including reducing systemic inflammation and mucus release.

Yes, certain types of beta-blockers can make COPD worse. An example is propranololwhich can make some COPD symptoms worse.

It was feared that other types of beta-blockers could increase mortality in people with severe forms of this disease. However, randomized clinical trials do not support this idea. In fact, numerous studies suggest that beta-blockers reduce death rates in people with COPD.

Some of the controversy surrounding this stems from a 2012 study. The authors reported that beta-blocker therapy increased mortality in people with COPD using home oxygen.

However, the participants in this study were over 75 years old. Sometimes beta-blockers can make heart problems worse in older people. Therefore, it is possible that age, rather than COPD, is the reason the study found these drugs caused higher death rates.

Additionally, the study did not assess the effects of beta-blockers on COPD exacerbations. Other research has shown that these drugs effectively reduce exacerbations in people at the highest risk of death from heart problems.

Beta blockers work by preventing hormones from reaching beta receptors. There are three kinds of beta-receptor:

  • beta-1 (B1) receptors, which are abundant in heart muscle and regulate its activity
  • beta-2 (B2) receptors, present in certain organs, influencing smooth muscle relaxation and metabolic activity
  • beta-3 (B3) receptors, which are responsible for the breakdown of fat cells

Selective beta-blockers target B1 receptors and act specifically on the heart. Conversely, non-selective beta-blockers target B1 and B2 receptors at various locations in the body.

Some common types beta blockers include:

  • acebutolol (Sectral)
  • betaxolol (Kerlone)
  • bisoprolol (Zebeta)
  • metoprolol (Lopressor, Toprol XL)
  • Nadolol (Corgard)
  • sotalol (betapace)
  • carvedilol (Coreg)

Doctors consider a variety of factors when deciding whether or not to prescribe beta-blockers for COPD.

They must take into account the potential for alterations in lung function against the risk heart failure and heart attacks. They may also take into account the person’s age and any other health conditions they have. For example, older people with COPD and other health conditions may not tolerate beta-blockers as well as younger people.

Finally, physicians should also consider interactions with other medications and potential side effects of beta-blockers. If the benefits outweigh the risks, they may recommend trying them.

People may not be able to take beta-blockers if they have certain medical conditions, including:

Previously, doctors doesn’t recommend beta-blockers to people with asthma. However, they can now recommend certain cardioselective beta-blockers at the lowest possible dose if there is clinical benefit to the person.

Some people may need to avoid certain beta-blockers. This can include people with long QT syndrome, when the heart muscle takes relatively longer to contract and relax than usual. People with torsades de pointes, a heart rhythm disturbance, may also need to avoid them. Indeed, the long QT syndrome and torsades de pointes can cause cardiac arrhythmias.

Also, people should not take beta-blockers with certain medications, including:

Before trying beta-blockers, it may be helpful to ask a doctor questions to make sure a person understands the pros and cons. They may want to ask:

  • What is the benefit of taking beta-blockers?
  • What type do you recommend?
  • What are the risks ?
  • What are the potential side effects?
  • How will taking beta-blockers affect my COPD symptoms?
  • Are there other treatment options?
  • What are the contraindications to beta-blocker therapy?

Beta-blockers are a type of medicine that doctors use for cardiovascular diseases, such as high blood pressure. A healthcare professional may suggest people with both COPD and cardiovascular disease take them to reduce stress on the heart.

There has been controversy around beta-blockers and COPD due to fears that they may increase mortality. However, recent evidence suggests that these drugs may help reduce acute exacerbations of COPD and improve mortality rates.

There are various contraindications to beta-blocker therapy, so doctors should decide on suitability based on an individual’s general health, symptoms of COPD, and other factors.