β受体阻滞剂对慢性阻塞性肺疾病（COPD）急性加重率和肺功能的影响。
Effect of beta-blockers on exacerbation rate and lung function in chronic obstructive pulmonary disease (COPD).
作者信息
Duffy Sean, Marron Robert, Voelker Helen, Albert Richard, Connett John, Bailey William, Casaburi Richard, Cooper J Allen, Curtis Jeffrey L, Dransfield Mark, Han MeiLan K, Make Barry, Marchetti Nathaniel, Martinez Fernando, Lazarus Stephen, Niewoehner Dennis, Scanlon Paul D, Sciurba Frank, Scharf Steven, Reed Robert M, Washko George, Woodruff Prescott, McEvoy Charlene, Aaron Shawn, Sin Don, Criner Gerard J
机构信息
Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA.
Department of Thoracic Medicine and Surgery, Temple University School of Medicine, 712 Parkinson Pavilion, 3401 North Broad Street, Philadelphia, PA, 19140, USA.
出版信息
Respir Res. 2017 Jun 19;18(1):124. doi: 10.1186/s12931-017-0609-7.
BACKGROUND
Beta-blockers are commonly prescribed for patients with cardiovascular disease. Providers have been wary of treating chronic obstructive pulmonary disease (COPD) patients with beta-blockers due to concern for bronchospasm, but retrospective studies have shown that cardio-selective beta-blockers are safe in COPD and possibly beneficial. However, these benefits may reflect symptom improvements due to the cardiac effects of the medication. The purpose of this study is to evaluate associations between beta-blocker use and both exacerbation rates and longitudinal measures of lung function in two well-characterized COPD cohorts.
METHODS
We retrospectively analyzed 1219 participants with over 180 days of follow up from the STATCOPE trial, which excluded most cardiac comorbidities, and from the placebo arm of the MACRO trial. Primary endpoints were exacerbation rates per person-year and change in spirometry over time in association with beta blocker use.
RESULTS
Overall 13.9% (170/1219) of participants reported taking beta-blockers at enrollment. We found no statistically significant differences in exacerbation rates with respect to beta-blocker use regardless of the prevalence of cardiac comorbidities. In the MACRO cohort, patients taking beta-blockers had an exacerbation rate of 1.72/person-year versus a rate of 1.71/person-year in patients not taking beta-blockers. In the STATCOPE cohort, patients taking beta-blockers had an exacerbation rate of 1.14/person-year. Patients without beta-blockers had an exacerbation rate of 1.34/person-year. We found no detrimental effect of beta blockers with respect to change in lung function over time.
CONCLUSION
We found no evidence that beta-blocker use was unsafe or associated with worse pulmonary outcomes in study participants with moderate to severe COPD.
背景
β受体阻滞剂常用于心血管疾病患者。由于担心支气管痉挛，医疗服务提供者一直对用β受体阻滞剂治疗慢性阻塞性肺疾病（COPD）患者持谨慎态度，但回顾性研究表明，心脏选择性β受体阻滞剂对COPD患者是安全的，而且可能有益。然而，这些益处可能反映的是药物心脏效应导致的症状改善。本研究的目的是评估在两个特征明确的COPD队列中，使用β受体阻滞剂与急性加重率及肺功能纵向指标之间的关联。
方法
我们回顾性分析了来自STATCOPE试验（排除了大多数心脏合并症）和MACRO试验安慰剂组的1219名随访超过180天的参与者。主要终点是与使用β受体阻滞剂相关的每人每年急性加重率和肺活量测定随时间的变化。
结果
总体而言，13.9%（170/1219）的参与者在入组时报告正在服用β受体阻滞剂。无论心脏合并症的患病率如何，我们发现使用β受体阻滞剂与急性加重率之间无统计学显著差异。在MACRO队列中，服用β受体阻滞剂的患者急性加重率为1.72/人年，未服用β受体阻滞剂的患者急性加重率为1.71/人年。在STATCOPE队列中，服用β受体阻滞剂的患者急性加重率为1.14/人年，未服用β受体阻滞剂的患者急性加重率为1.34/人年。我们发现β受体阻滞剂对肺功能随时间的变化没有不利影响。
结论
我们没有发现证据表明，在中度至重度COPD研究参与者中，使用β受体阻滞剂不安全或与更差的肺部结局相关。
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