Salpeter S S, Ormiston T, Salpeter E, Poole P, Cates C
Medicine, Stanford University, Santa Clara Valley Medical Center, 2400 Moorpark Ave, Suite 118, San Jose, CA 95128, USA.
Cochrane Database Syst Rev. 2002(2):CD003566. doi: 10.1002/14651858.CD003566.
Beta-blocker therapy has a proven mortality benefit in patients with hypertension, heart failure and coronary artery disease, as well as during the perioperative period. These drugs have traditionally been considered contraindicated in patients with chronic obstructive pulmonary disease (COPD).
To assess the effect of cardioselective beta-blockers on respiratory function of patients with COPD.
A comprehensive search of EMBASE, MEDLINE and CINAHL was performed using the Cochrane Airways Group registry to identify randomised blinded controlled trials from 1966 to May 2001. The search was completed using the terms: asthma*, bronchial hyperreactivity*, respiratory sounds*, wheez*, obstructive lung disease* or obstructive airway disease*, and adrenergic antagonist*, sympatholytic* or adrenergic receptor block*. We did not exclude trials on the basis of language.
Randomised, blinded, controlled trials of single dose or longer duration that studied the effects of cardioselective beta-blockers on the forced expiratory volume in 1 second (FEV1) or symptoms in patients with COPD.
Two independent reviewers extracted data from the selected articles, reconciling differences by consensus. Two interventions studied were the administration of beta-blocker, given either as a single dose or for longer duration, and the use of beta2-agonist given after the study drug.
Eleven studies of single-dose treatment and 8 of treatment for longer duration, ranging from 2 days to 12 weeks, met selection criteria. Cardioselective beta-blockers produced no statistically significant change in FEV1 or respiratory symptoms compared to placebo, given as a single dose (Weighted Mean Difference -2.05% [95% Confidence interval, -6.05 to 1.96%]) or for longer duration (WMD -2.55% [95% CI, -5.94 to 0.84]), and did not significantly affect the FEV1 treatment response to beta2-agonists. Exacerbations and hospitalizations were recorded in all trials, but none occurred during the periods of study, in either group. A subgroup analysis revealed no significant change in results for those participants with severe chronic airways obstruction or for those with a reversible obstructive component.
REVIEWER'S CONCLUSIONS: The available evidence suggests that cardioselective beta-blockers, given to patients with COPD do not produce a significant short-term reduction in airway function or in the incidence of COPD exacerbations. However, the trials were small and of short duration. Given their demonstrated benefit in conditions such as heart failure, coronary artery disease and hypertension, cardioselective beta-blockers should be considered for patients with COPD, but administered with careful monitoring since data concerning long term administration and their effects during exacerbations are not available.
β受体阻滞剂疗法已被证明对高血压、心力衰竭和冠状动脉疾病患者以及围手术期患者有降低死亡率的益处。传统上，这些药物被认为是慢性阻塞性肺疾病（COPD）患者的禁忌药。
评估心脏选择性β受体阻滞剂对COPD患者呼吸功能的影响。
使用Cochrane气道组注册库对EMBASE、MEDLINE和CINAHL进行全面检索，以识别1966年至2001年5月期间的随机双盲对照试验。检索使用的术语为：哮喘*、支气管高反应性*、呼吸音*、喘息*、阻塞性肺疾病或阻塞性气道疾病，以及肾上腺素能拮抗剂*、抗交感神经药或肾上腺素能受体阻滞剂。我们没有基于语言排除试验。
研究心脏选择性β受体阻滞剂对COPD患者一秒用力呼气量（FEV1）或症状影响的单剂量或较长疗程的随机、双盲、对照试验。
两名独立的审阅者从选定的文章中提取数据，通过协商一致解决分歧。研究的两种干预措施是给予β受体阻滞剂，单剂量或较长疗程给药，以及在研究药物后使用β2激动剂。
11项单剂量治疗研究和8项疗程从2天到12周不等的较长疗程治疗研究符合入选标准。与安慰剂相比，心脏选择性β受体阻滞剂单剂量给药（加权平均差-2.05%[95%置信区间，-6.05至1.96%]）或较长疗程给药（加权平均差-2.55%[95%置信区间，-5.94至0.84]）时FEV1或呼吸症状无统计学显著变化，且对β2激动剂的FEV1治疗反应无显著影响。所有试验均记录了病情加重和住院情况，但两组在研究期间均未发生。亚组分析显示，对于严重慢性气道阻塞患者或有可逆性阻塞成分的患者，结果无显著变化。
现有证据表明，给予COPD患者心脏选择性β受体阻滞剂不会导致气道功能短期内显著降低或COPD病情加重发生率显著降低。然而，试验规模较小且持续时间较短。鉴于其在心力衰竭、冠状动脉疾病和高血压等疾病中已证明的益处，对于COPD患者应考虑使用心脏选择性β受体阻滞剂，但由于缺乏关于长期给药及其在病情加重期间影响的数据，应在密切监测下给药。
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