Salpeter S R, Ormiston T M, Salpeter E E, Poole P J, Cates C J
Stanford University School of Medicine, CA, USA.
Respir Med. 2003 Oct;97(10):1094-101. doi: 10.1016/s0954-6111(03)00168-9.
Beta-blocker therapy has a 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). The objective of this study was to assess the effect of cardioselective beta-blockers on respiratory function of patients with COPD. Comprehensive searches were performed of the EMBASE, MEDLINE and CINAHL databases from 1966 to May 2001, and identified articles and related reviews were scanned. Randomised, blinded, controlled trials that studied the effects of cardioselective beta-blockers on the forced expiratory volume in 1 s (FEV1) or symptoms in patients with COPD were included in the analysis. 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. Outcomes measured were the change in FEV1 from baseline and the number of patients with respiratory symptoms. Eleven studies of single-dose treatment and 8 of continued treatment were included. Cardioselective beta-blockers produced no significant change in FEV1 or respiratory symptoms compared to placebo, given as a single dose (-2.05% [95% CI, -6.05% to 1.96%]) or for longer duration (-2.55% [CI, -5.94% to 0.84]), and did not significantly affect the FEV1 treatment response to beta2-agonists. Subgroup analyses revealed no significant change in results for those participants with severe chronic airways obstruction or for those with a reversible obstructive component. In conclusion, cardioselective beta-blockers given to patients with COPD do not produce a significant reduction in airway function or increase the incidence of COPD exacerbations. 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.
β受体阻滞剂治疗对高血压、心力衰竭和冠心病患者以及围手术期患者具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）患者的禁忌用药。本研究的目的是评估心脏选择性β受体阻滞剂对COPD患者呼吸功能的影响。我们对1966年至2001年5月期间的EMBASE、MEDLINE和CINAHL数据库进行了全面检索，并对检索到的文章及相关综述进行了筛选。分析纳入了研究心脏选择性β受体阻滞剂对COPD患者1秒用力呼气量（FEV1）或症状影响的随机、双盲、对照试验。所研究的干预措施包括给予单剂量或较长疗程的β受体阻滞剂，以及在研究药物后使用β2激动剂。测量的结果包括FEV1相对于基线的变化以及出现呼吸道症状的患者数量。纳入了11项单剂量治疗研究和8项持续治疗研究。与安慰剂相比，单剂量（-2.05%[95%CI，-6.05%至1.96%]）或较长疗程（-2.55%[CI，-5.94%至0.84]）给予心脏选择性β受体阻滞剂时，FEV1或呼吸道症状均无显著变化，且对β2激动剂的FEV1治疗反应无显著影响。亚组分析显示，对于重度慢性气道阻塞患者或具有可逆性阻塞成分的患者，结果无显著变化。总之，给予COPD患者心脏选择性β受体阻滞剂不会显著降低气道功能或增加COPD急性加重的发生率。鉴于其在心力衰竭、冠心病和高血压等疾病中已证实的益处，对于COPD患者应考虑使用心脏选择性β受体阻滞剂。
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