Beta-blockers are medications that doctors may recommend for cardiovascular disease, which is common in people with chronic obstructive pulmonary disorder (COPD). However, their use is not without controversy.

COPD is a progressive lung disease that makes breathing difficult. Some researchers have concerns that beta-blockers may increase mortality for those with severe COPD who use oxygen at home. However, recent studies have not suggested that these medications carry this risk.

This article looks at beta-blockers and COPD, including what they do, their benefits, risks, and types.

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Beta-blockers are medications that reduce stress on the heart and blood vessels. Doctors prescribe them to manage cardiovascular conditions, such as high blood pressure and angina. They can also prescribe them for anxiety, migraine, tremors, and other conditions.

Beta-blockers work by blocking the action of stress hormones that the body releases during the “fight or flight” response. This includes adrenaline and noradrenaline.

Adrenaline increases heart rate and blood pressure, which can put harmful stress on the heart for those with cardiovascular disease. The fight or flight response also results in sweating, anxiety, and jitteriness.

Beta-blockers slow the heart rate and reduce the force of contraction. They also cause the relaxation of blood vessels. All of these lead to lower blood pressure.

Additionally, beta-blockers mainly affect beta 1 receptors in the heart. Blocking these receptors leads to a reduced heart rate and the force of heart muscle contraction. However, these medications also affect beta 2 receptors in blood vessels and bronchi. Blocking these receptors leads to smooth muscle contraction, narrowing airways and increasing blood pressure. So there is a concern that nonselective beta-blockers can worsen airway obstruction by narrowing the airways.

Yes, in some cases, beta-blockers can help with COPD. This is because people with the condition often also have problems with their cardiovascular system, due to the effects of factors such as:

  • systemic inflammation
  • genetic susceptibility
  • smoking
  • older age

A 2021 review of 23 observational studies and 14 randomized clinical trials linked beta-blocker use with a decreased risk of acute COPD exacerbations. An acute COPD exacerbation is a sudden increase in symptoms such as cough, sputum production, and difficulty breathing.

The review also suggested that beta-blockers reduced mortality and improved quality of life. An exception was propranolol, which decreased forced expiratory volume 1, a measure of air exhalation. This suggests that propranolol may reduce lung function.

Beta-blockers may also have useful noncardiac effects, including reducing systemic inflammation and mucus release.

Yes, some types of beta-blockers can make COPD worse. One example is propranolol, which may worsen some COPD symptoms.

There have been concerns that other types of beta-blockers could increase mortality among people with severe forms of this condition. However, randomized clinical trials do not support this idea. In fact, many studies suggest that beta-blockers reduce mortality rates in people with COPD.

Some of the controversy surrounding this stems from a 2012 study. The authors reported that beta-blocker therapy increased mortality in individuals with COPD using oxygen at home.

However, the participants in this study were over 75 years old. Sometimes, beta-blockers can worsen heart conditions in older adults. Therefore, it is possible that age, rather than COPD, was why the study found that these medications resulted in higher mortality rates.

Additionally, the study did not assess the effects of beta-blockers on COPD exacerbations. Other research has found that these medications effectively reduce exacerbations in people with the highest risk of death from heart problems.

Beta-blockers work by preventing hormones from reaching beta receptors. There are three types of beta-receptor:

  • beta-1 (B1) receptors, which are abundant in the heart muscle and regulate its activity
  • beta-2 (B2) receptors, which are present in some organs, influencing smooth muscle relaxation and metabolic activity
  • beta-3 (B3) receptors, which are responsible for breaking down fat cells

Selective beta-blockers target B1 receptors and work specifically on the heart. Conversely, nonselective beta-blockers target B1 and B2 receptors in various places around the body.

Some common types of beta-blocker include:

  • acebutolol (Sectral)
  • betaxolol (Kerlone)
  • bisoprolol (Zebeta)
  • metoprolol (Lopressor, Toprol XL)
  • nadolol (Corgard)
  • sotalol (Betapace)
  • carvedilol (Coreg)

There are various factors that doctors consider when deciding whether to prescribe beta-blockers for COPD.

They must take into account the potential for lung function alterations versus the risk of heart failure and heart attacks. They may also consider the individual’s age and any other health conditions they have. For example, older people with COPD and other health problems may not tolerate beta-blockers as well as younger individuals.

Finally, doctors must also consider interactions with other medications and the potential side effects of beta-blockers. If the benefits outweigh the risks, they may recommend trying them.

People may not be able to take beta-blockers if they have certain medical conditions, including:

Previously, doctors did not recommend beta-blockers for people with asthma. However, they may now recommend certain cardioselective beta-blockers at the lowest possible dose if there is a clinical benefit to the person.

Some individuals may need to avoid specific beta-blockers. This may include those with long QT syndrome, when the heart muscle takes a comparatively longer time to contract and relax than usual. Individuals with torsade de pointes, a disturbance of the heart’s rhythm, may also need to avoid them. This is because both long QT syndrome and torsade de pointes can cause heart arrhythmias.

Additionally, people should not take beta-blockers alongside certain medications, including:

Before trying beta-blockers, it can help to ask a doctor questions to ensure a person understands the advantages and disadvantages. They may wish to ask:

  • What is the benefit of taking beta-blockers?
  • Which type do you recommend?
  • What are the risks?
  • What are the potential side effects?
  • How will taking beta-blockers affect my COPD symptoms?
  • Are there any other treatment options?
  • What are the contraindications for beta-blocker therapy?

Beta-blockers are a type of medication that doctors use for cardiovascular conditions, such as high blood pressure. A healthcare professional may suggest that people with both COPD and cardiovascular disease take them to reduce stress on the heart.

There has been controversy surrounding beta-blockers and COPD due to concerns they may increase mortality. However, recent evidence suggests that these medications may help reduce acute COPD exacerbations and improve mortality rates.

There are various contraindications of beta-blocker therapy, so doctors must decide on the suitability according to an individual’s overall health, COPD symptoms, and other factors.