Therapeutic Evaluation Unit, British Columbia Provincial Health Services Authority, Vancouver, Canada.
BMC Pulm Med. 2012 Sep 4;12:48. doi: 10.1186/1471-2466-12-48.
Despite the benefits of beta-blockers in patients with established or sub-clinical coronary artery disease, their use in patients with chronic obstructive pulmonary disease (COPD) has been controversial. Currently, no systematic review has examined the impact of beta-blockers on mortality in COPD.
We systematically searched electronic bibliographic databases including MEDLINE, EMBASE and Cochrane Library for clinical studies that examine the association between beta-blocker use and all cause mortality in patients with COPD. Risk ratios across studies were pooled using random effects models to estimate a pooled relative risk across studies. Publication bias was assessed using a funnel plot.
Our search identified nine retrospective cohort studies that met the study inclusion criteria. The pooled relative risk of COPD related mortality secondary to beta-blocker use was 0.69 (95% CI: 0.62-0.78; I2=82%).
The results of this review are consistent with a protective effect of beta-blockers with respect to all cause mortality. Due to the observational nature of the included studies, the possibility of confounding that may have affected these results cannot be excluded. The hypothesis that beta blocker therapy might be of benefit in COPD needs to be evaluated in randomised controlled trials.
尽管β受体阻滞剂在已确诊或亚临床冠状动脉疾病患者中有益，但在慢性阻塞性肺疾病（COPD）患者中的应用仍存在争议。目前，尚无系统评价研究β受体阻滞剂对 COPD 患者死亡率的影响。
我们系统地检索了 MEDLINE、EMBASE 和 Cochrane 图书馆等电子文献数据库，以查找评估β受体阻滞剂使用与 COPD 患者全因死亡率之间关联的临床研究。使用随机效应模型汇总研究间的风险比，以估计研究间的 pooled relative risk。使用漏斗图评估发表偏倚。
我们的检索共确定了 9 项符合研究纳入标准的回顾性队列研究。β受体阻滞剂使用与 COPD 相关死亡率的 pooled relative risk 为 0.69（95%CI：0.62-0.78；I2=82%）。
本综述的结果与β受体阻滞剂对全因死亡率的保护作用一致。由于纳入研究的观察性质，可能影响这些结果的混杂因素无法排除。β受体阻滞剂治疗在 COPD 中可能有益的假设需要在随机对照试验中进行评估。
