Cardioselective β-Blockers for COPD Patients?

Non-cardioselective β-blockers can provoke or worsen bronchospasm in patients with chronic obstructive pulmonary disease (COPD) or asthma. In contrast, cardioselective β-blockers (e.g., metoprolol) are thought to be relatively safe for such patients. In fact, observational studies have suggested that these drugs might lower exacerbation rates and mortality in COPD patients (NEJM JW Hosp Med Aug 2010 and JAMA Intern Med 2010; 170:880). To test this possibility, U.S. researchers conducted a randomized trial that involved 532 COPD patients, most of whom had moderate or severe disease (mean forced expiratory volume in 1 second [FEV₁], 41% of predicted value) and at least one exacerbation during the previous year. Patients with cardiovascular in…