The mortality and incidence of chronic obstructive pulmonary disease (COPD) and coronary heart disease increase with age. Despite the clear evidence of beta blockers (BBs) effectiveness, there is a general reluctance to use them in patients with COPD due to a perceived contraindication and fear of inducing adverse reactions and bronchspasm. BBs are well tolerated in patients with cardiac disease and concomitant COPD with no evidence of worsening of respiratory symptoms or FEV1, and the safety of BBs in patients with COPD has been demonstrated, but their use in this group of patients remains low. The cumulative evidence from trials and meta-analysis indicates that cardioselective BBs should not be withheld in patients with reactive airway disease or COPD. Patients with COPD have a high incidence of cardiac events necessitating careful consideration of prophylactic treatment. The benefits of beta blockade in this group appear to outweigh any potential risk of side effects according to the available evidence. In this article, we will discuss the use of BBs in patients with COPD and review the evidence for their use and safety in this group of patients.