Ruzieh Mohammed, Baugh Aaron D, Al Jebbawi Lama, Edwards Emily S, Jia Kelly Qi, Dransfield Mark T, Foy Andrew J
Division of Cardiovascular Medicine. University of Florida, Gainesville, FL.
Pulmonary, Critical Care, Allergy, and Sleep Medicine. University of California San Francisco, San Francisco, CA.
Trends Cardiovasc Med. 2023 Jan;33(1):53-61. doi: 10.1016/j.tcm.2021.11.004. Epub 2021 Nov 29.
Beta-blockers (βB) are a frequently used class of medications. Although βB have many indications, those related to cardiovascular disease are among the most common and important. However, in patients with chronic obstructive pulmonary disease (COPD), βB are used less often due to concerns about an unfavorable impact on respiratory morbidity and mortality. We performed a systematic review to assess the safety of βB in patients with COPD. We included a total of 2 randomized controlled trials and 28 observational studies. The majority found statistically significant reductions in mortality. The two higher quality observational studies reported increased mortality with βB. The risk of COPD exacerbations was reduced in about half of the studies. Nonetheless, there were significant biases that confounded the results. The highest quality RCT found a significant increase in severe and very severe COPD exacerbations with βB use. In conclusion, data on the safety of βB in patients with COPD are conflicting. However, given higher quality evidence showed harm with their use, βB should be prescribed with caution in patients with COPD, including patients with cardiac indication for βB.
β受体阻滞剂（βB）是一类常用药物。尽管βB有多种适应证，但与心血管疾病相关的适应证是最常见且最重要的。然而，在慢性阻塞性肺疾病（COPD）患者中，由于担心对呼吸发病率和死亡率产生不利影响，βB的使用频率较低。我们进行了一项系统评价，以评估βB在COPD患者中的安全性。我们共纳入了2项随机对照试验和28项观察性研究。大多数研究发现死亡率有统计学意义的降低。两项质量较高的观察性研究报告称，使用βB会增加死亡率。约一半的研究中COPD急性加重的风险降低。尽管如此，仍存在显著偏倚混淆了结果。质量最高的随机对照试验发现，使用βB会使重度和极重度COPD急性加重显著增加。总之，关于βB在COPD患者中安全性的数据相互矛盾。然而，鉴于更高质量的证据显示使用βB有危害，在COPD患者中应谨慎开具βB处方，包括有βB心脏适应证的患者。
