Leitao Filho Fernando Sergio, Choi Lauren, Sin Don D
Centre for Heart Lung Innovation, St. Paul's Hospital.
Division of Respiratory Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
Curr Opin Pulm Med. 2021 Mar 1;27(2):125-131. doi: 10.1097/MCP.0000000000000748.
Several observational studies have suggested that β-blockers, especially cardioselective ones, are well tolerated and associated with a lower risk of acute exacerbations and death in patients with chronic obstructive pulmonary disease (COPD). However, there are dissenting studies. This review provides an update on the use of β-blockers in COPD, focusing on results of recent prospective studies and randomized controlled trials.
In totality, cohort studies indicate that β-blockers are generally well tolerated and effective in COPD patients who also have a clear cardiovascular indication for these medications. Although β-blockers on average reduce lung function acutely in COPD patients, the absolute decrease is relatively small, especially if cardioselective β-blockers are used. The results of two large randomized controlled trials suggest that β-blocker use does not reduce the therapeutic benefits of inhaled bronchodilators in COPD patients. The use of β-blockers in COPD patients, who do not have overt cardiovascular disease, does not prevent COPD exacerbations and may paradoxically increase the risk of COPD-related hospitalization and mortality.
The use of β-blockers is generally well tolerated and effective in COPD patients, who also have a clear cardiovascular indication for these drugs. However, they should not be used in patients who do not have overt cardiovascular disease as β-blockers can reduce lung function, worsen health status and increase the risk of COPD-related hospitalization.
多项观察性研究表明，β受体阻滞剂，尤其是心脏选择性β受体阻滞剂，耐受性良好，且与慢性阻塞性肺疾病（COPD）患者急性加重和死亡风险较低相关。然而，也有不同观点的研究。本综述提供了关于COPD患者使用β受体阻滞剂的最新情况，重点关注近期前瞻性研究和随机对照试验的结果。
总体而言，队列研究表明，β受体阻滞剂在有明确心血管适应证的COPD患者中通常耐受性良好且有效。虽然β受体阻滞剂平均会使COPD患者的肺功能急性下降，但绝对下降幅度相对较小，尤其是使用心脏选择性β受体阻滞剂时。两项大型随机对照试验的结果表明，使用β受体阻滞剂不会降低COPD患者吸入支气管扩张剂的治疗效果。在没有明显心血管疾病的COPD患者中使用β受体阻滞剂，不能预防COPD急性加重，反而可能反常地增加COPD相关住院和死亡风险。
β受体阻滞剂在有明确心血管适应证的COPD患者中通常耐受性良好且有效。然而，在没有明显心血管疾病的患者中不应使用，因为β受体阻滞剂会降低肺功能、恶化健康状况并增加COPD相关住院风险。
