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The safety of β-blockers in patients with chronic obstructive pulmonary disease (COPD) has long been debated. On the one hand, even cardioselective β-blockers have some effect on airway β2 receptors that theoretically could worsen airflow. On the other hand, several observational studies have suggested that β-blockers actually might lower risk for COPD exacerbations — and several theoretical mechanisms have been proposed to explain that observation.
In this randomized trial, U.K. researchers identified 519 patients (mean age, 68) with mostly moderate COPD (mean forced expiratory volume in 1 second [FEV1], 50%), ≥2 exacerbations during the previous year, and no cardiovascular (CV) indications for β-blockers. Patients were randomized to receiv…