Neef Pieter A, Burrell Louise M, McDonald Christine F, Irving Louis B, Johnson Douglas F, Steinfort Daniel P
Department of General Medicine, Austin Health, Melbourne, Victoria, Australia.
Department of Medicine and Cardiology, The University of Melbourne, Melbourne, Victoria, Australia.
Intern Med J. 2017 Sep;47(9):1043-1050. doi: 10.1111/imj.13518.
In patients with chronic obstructive pulmonary disease (COPD) and co-morbid cardiovascular disease, emerging evidence suggests a benefit in commencing cardioselective beta-blockers.
Our objective was to determine the safety of beta-blocker commencement during hospitalisation for acute exacerbation of COPD.
A retrospective cohort study of 1071 patients hospitalised for acute exacerbation of COPD was conducted across two tertiary hospitals over a 12-month period. We identified 36 patients in whom beta-blocker therapy was commenced during admission. The primary outcome of the study was to assess cardiovascular and respiratory adverse events related to the commencement of beta-blocker therapy.
The most common indications for beta-blockers were atrial fibrillation (53%) and acute coronary syndrome (36%). Metoprolol was the most commonly prescribed beta-blocker (75%). No patients suffered clinically significant declines of respiratory function following the commencement of a beta-blocker, including worsening respiratory symptoms, oxygen, bronchodilator or ventilation requirements. These results were demonstrable in patients with reversible airways disease and advanced COPD. Only one patient (2.8%) experienced symptomatic hypotension after 48 h of therapy.
The commencement of cardioselective beta-blockers during acute exacerbations of COPD appears to be well-tolerated.
在患有慢性阻塞性肺疾病（COPD）合并心血管疾病的患者中，新出现的证据表明开始使用心脏选择性β受体阻滞剂有益。
我们的目标是确定在COPD急性加重住院期间开始使用β受体阻滞剂的安全性。
在12个月期间，对两家三级医院收治的1071例因COPD急性加重住院的患者进行了一项回顾性队列研究。我们确定了36例在入院期间开始使用β受体阻滞剂治疗的患者。该研究的主要结局是评估与开始使用β受体阻滞剂治疗相关的心血管和呼吸不良事件。
β受体阻滞剂最常见的适应证是心房颤动（53%）和急性冠状动脉综合征（36%）。美托洛尔是最常用的β受体阻滞剂（75%）。开始使用β受体阻滞剂后，没有患者出现临床上显著的呼吸功能下降，包括呼吸症状恶化、氧气需求、支气管扩张剂需求或通气需求。这些结果在可逆性气道疾病和晚期COPD患者中得到证实。只有1例患者（2.8%）在治疗48小时后出现症状性低血压。
在COPD急性加重期间开始使用心脏选择性β受体阻滞剂似乎耐受性良好。
