AB014. Effect of beta-blockers on the risk of COPD exacerbations
Lies Lahousse1,2, Phebe De Nocker2, A. Hofman2, Bruno H. Stricker2, Guy G. Brusselle1,2, Katia M. C. Verhamme3
Background: While β-blockers are known to be protective in patients with cardiovascular disease, retrospective studies have suggested that β-blockers also have beneficial effects in patients with chronic obstructive pulmonary disease (COPD). To investigate whether (cardioselective) β-blockers have a beneficial effect on the risk of COPD exacerbations.
Methods: This nested case-control study is embedded within the Rotterdam Study, a prospective population-based cohort study among 15,000 subjects aged 45 years and older with long-term follow-up (up to 25 years). COPD subjects were followed until the first moderate to severe COPD exacerbation. A Cox proportional hazards regression analyses was conducted adjusting for age, sex, smoking status and all factors that changed the matched estimate with 10%. A stratified analysis was conducted in patients with or without heart failure.
Results: Within the cohort of 1,621 COPD patients, 1,136 patients developed COPD exacerbations during 11,600 person years of follow-up (of which 268 exacerbations were severe). Current use of β-blockers was associated with a 21% reduced risk of COPD exacerbations (HR adjusted 0.79; 95% CI, 0.67–0.94), driven by the use of cardioselective β-blockers (HRadj 0.79; 95% CI, 0.65–0.95), while no protective effect was observed for non-cardioselectiveβ-blockers though numbers were low (HRadj 1.01; 95% CI, 0.66–1.56). This association was strongest for COPD patients with heart failure (n=109; HRadj 0.45; 95% CI, 0.23–0.87). Regarding severe exacerbations, current use of β-blockers was associated with a 15% risk reduction, though this was statistically not significant (HRadj 0.85; 95% CI, 0.58–1.24).
Conclusions: Use of cardioselective β-blockers is associated with a reduced risk of COPD exacerbations. Further research should reveal whether this association is causal or due to confounding, and whether reduced exacerbation risk translates in reduced mortality.
Keywords: Beta-Blockers (β-blockers); chronic obstructive pulmonary disease exacerbations (COPD exacerbations); cohort study
doi: 10.21037/jtd.2016.s014
