Tables
- TABLE 1
Characteristics of the studies using beta-blockers in patients with chronic obstructive pulmonary disease (COPD) and cardiovascular comorbidities
First author [ref.] Year Design Population Safety outcome Salpeter [15] 2005 Review of data from 22 randomised, blinded controlled trials 1567 patients with COPD No adverse effect of cardioselective beta-blockers on lung function or respiratory symptoms compared to placebo Short [16] 2011 Retrospective cohort study using a disease-specific database of COPD patients (TARDIS) 5977 patients aged >50 years with COPD Reductions in mortality, exacerbations and hospital admissions; additive benefits with inhaled therapy; 88% of beta-blockers used were cardioselective Etminan [14] 2012 Systematic review and meta-analysis of nine retrospective cohort studies 99 877 patients with COPD Protective effect of beta-blockers (selective and non-selective) with respect to all-cause mortality Stefan [2] 2012 Retrospective cohort study 35 082 patients aged >40 years with COPD and coexistent ischaemic heart disease, chronic heart failure or hypertension β1-selective beta-blocker therapy among chronic users appears to be safe during a hospitalisation for acute COPD exacerbation; β1-selective beta-blockers are superior to non-selective beta-blockers in this category of patients Zeng [17] 2013 Retrospective cohort study 220 elderly male COPD patients (mean±sd age 84.1±6.9 years) No association between the use of β2-agonists, beta-blockers or beta-blocker/β2-agonist combination therapy with cardiac function and all-cause mortality in elderly male COPD patients TARDIS: Tayside Allergy and Respiratory Disease Information System.
- TABLE 2
Classification of the most common beta-blockers according to selective and non-selective properties
Non-selective β1-selective β1- and β2-blockers α- and β-blockers ISA− ISA+ Propranolol
40–280 mg twice dailyLabetalol
200 mg twice dailyAtenolol
25–100 mg once or twice dailyNebivolol
5–10 mg once dailySotalol
80–160 mg twice dailyCarvedilol
12.5–50 mg twice dailyMetoprolol
100 mg once or twice dailyAcebutolol
200–800 once dailyNadolol
40–320 mg once dailyBisoprolol
2.5–10 mg once dailyEsmolol
50–200 μg·kg−1·min−1Data are presented as usual dosage in clinical practice. ISA: intrinsic sympathetic activity.
- TABLE 3
Characteristics of studies using long-acting β-agonists (LABAs) and/or long-acting muscarinic receptor antagonists (LAMAs) in patients with chronic obstructive pulmonary disease (COPD) and cardiovascular comorbidities
First author [ref.] Year Design Population Safety outcome Tricco [22] 2015 Systematic review and network meta-analysis of 208 randomised clinical trials 134 692 adults with COPD No statistically significant differences in risks of serious arrhythmia across any of the compared agents Tashkin [23] 2015 Post hoc analysis of all-cause mortality and serious cardiac adverse events using data from the UPLIFT study 6562 patients with COPD with recent myocardial infarction, heart failure or unstable rhythm disorder Risk of cardiac events, mortality or SAEs was not increased by tiotropium versus placebo in patients experiencing cardiac events Oba [24] 2016 Systematic review and network meta-analysis of 23 trials 27 172 patients older than 35 or 40 years with a diagnosis of COPD Combination therapy had similar effects on safety outcomes, including mortality, total SAEs, cardiac SAEs and dropouts, compared with monotherapy Calzetta [25] 2016 Systematic review and meta-analysis of 22 randomised clinical trials 23 168 with a diagnosis of COPD No evidence of any significant difference concerning the cardiac safety profile of combination therapy compared with monocomponents Lahousse [26] 2016 Review of 93 studies about cardiac safety of bronchodilatator therapy in COPD >700 000 patients with a diagnosis of COPD LAMAs and/or LABAs are safe when used in the appropriate dose in adherent patients with COPD without uncontrolled cardiovascular disease or other notable comorbidities; cardiac safety is less evident when used inappropriately (e.g. overdosing) or in patients with COPD and substantial cardiovascular disease, prolonged QTc interval or polypharmacy UPLIFT: Understanding Potential Long-term Impacts on Function with Tiotropium; SAEs: severe adverse effects.
Vol 26 Issue 145
Table of Contents
Effectiveness and safety of concurrent beta-blockers and inhaled bronchodilators in COPD with cardiovascular comorbidities
