Chronic obstructive pulmonary disease (COPD) almost never occurs in a vacuum, ie, rarely in the absence of one or more challenging comorbidities. Patients with COPD have a higher incidence of heart disease in the form of heart failure, coronary disease with acute coronary syndromes, and hypertension.1,2,3 In fact, hypertension is the most common comorbidity seen in patients with COPD.1 How is COPD, especially when accompanied by hypertension and heart disease, optimally treated? Well, herein lies a rub, so-to-speak. On one hand, beta blockers (β-blockers) are beneficial for various heart diseases; on the other, they may worsen bronchoconstriction in individuals with COPD. Let’s consider some questions.
1. Although β-blockers may decrease FEV1 in patients with COPD, which of the following are proven benefits of these agents in this population? (more than one option may be correct)
A. Following a myocardial infarction, β-blockers reduced mortality 40% in persons with and without COPD.
B. In patients with heart failure and COPD, those taking β-blockers had fewer exacerbations and fewer emergency department visits (for both cardiovascular and respiratory complications) than those not prescribed β-blockers.
C. β-blockers should be held in COPD patients during COPD exacerbations.