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Impact of selective and nonselective beta-blockers on the risk of severe exacerbations in patients with COPD.

Abstract：

BACKGROUND:There is conflicting information regarding the effects of selective and nonselective beta-blocker treatment in patients with COPD. PARTICIPANTS AND METHODS:This nested case-control study used the Taiwan National Health Insurance Research Database. We included COPD patients who used inhalation steroid and beta-blockers between 1998 and 2010. From this cohort, there were 16,067 patients with severe exacerbations included in the analysis and 55,970 controls matched on age, sex, COPD diagnosis year, and beta-blockers treatment duration by risk set sampling. RESULTS:For the selective beta-blocker users, the current users had a lower risk of severe exacerbations than the nonusers (odds ratio [OR], 0.90; 95% confidence interval [CI], 0.85-0.96). In contrast, for the nonselective beta-blocker users, the current users had a higher risk of severe acute exacerbations than the nonusers (OR, 1.21; 95% CI, 1.14-1.27). A higher risk of severe exacerbation during increasing mean daily dose or within about the initial 300 days was found in nonselective beta-blockers, but not in selective beta-blockers. One selective beta-blocker, betaxolol, had a significantly lower risk of severe exacerbations (OR, 0.75; 95% CI, 0.60-0.95). Two nonselective beta-blockers (labetalol and propranolol) were associated with a significantly higher risk of exacerbations (OR, 1.49; 95% CI, 1.32-1.67 for labetalol; OR, 1.16; 95% CI, 1.10-1.23 for propranolol). CONCLUSION:Selective beta-blockers can be cautiously prescribed for patients with COPD and cardiovascular disease (CVD), however, nonselective beta-blockers should not be prescribed for patients with COPD. Betaxolol may be the preferred choice of suitable selective beta-blocker for patients with COPD, however, labetalol and propranolol should be avoided for patients with COPD.

journal_name

Int J Chron Obstruct Pulmon Dis

journal_title

International journal of chronic obstructive pulmonary disease

authors

Huang YL,Lai CC,Wang YH,Wang CY,Wang JY,Wang HC,Yu CJ,Chen L

doi

10.2147/COPD.S145913

subject

Has Abstract

pub_date

2017-10-11 00:00:00

pages

2987-2996

eissn

1176-9106

issn

1178-2005

pii

copd-12-2987

journal_volume

pub_type

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Impact of selective and nonselective beta-blockers on the risk of severe exacerbations in patients with COPD.