Researchers at the University of Dundee in Scotland and the University of Aberdeen in the United Kingdom said a breakthrough study has shown that the use of the selective beta-blocker bisoprolol, which has conventionally been thought to increase the risk of a COPD flare up, can help the hearts of COPD patients without damaging the lungs. The paper was published in the Journal of the American Medical Association.
Metoprolol, the most used beta-blocker in the U.S., is less selective than bisoprolol and may therefore have more adverse respiratory effects by binding to beta-2 receptors in the lungs, making them potentially less suitable for COPD patients. A previous study had shown that metoprolol use resulted in increased hospital admissions due to COPD.
The Bisoprolol in COPD Study (BICS), led by Brian Lipworth, MD, FACAAI, from Dundee’s School of Medicine, and Graham Devereux, MD, PhD, previously at the University of Aberdeen and now of the Liverpool School of Tropical Medicine, followed more than 500 patients for one year to explore the effects of bisoprolol in patients with COPD. Using the standard inhaler treatment for COPD along with the addition of bisoprolol or a placebo, the study showed that there was no difference in exacerbations when treating patients associated with the beta-blocker.
“A series of pioneering studies performed in Tayside dating back to 1991 carefully evaluated the selectivity of beta-blockers, including bisoprolol, looking at the effects on the heart and lungs in patients with COPD and asthma,” Dr. Lipworth said. “This research culminated in the present multicenter trial looking at effects on exacerbations in COPD. It reassuringly shows that bisoprolol is safe to use when given in addition to conventional inhaled therapy in COPD. Bisoprolol should therefore not be withheld for such patients who also have heart disease where a selective beta-blocker is indicated. Our results differentiate bisoprolol from metoprolol in terms of being safe to use in COPD, which is in keeping with its superior selectivity.”
This study, which was presented at American Thoracic Society 2024 conference in San Diego, sheds light on the underuse of beta-blockers in COPD treatment despite their potential benefits in managing cardiovascular risks, providing valuable insights for physicians and helping patients navigate complex treatment decisions.
