Wednesday, August 17, 2011

beta blockers in COPD

It has been a looong gap ....moving and starting a fellowship in a new place is a little tough. Anyway I have settled down in my new place now. 
Let me start with a short blog..regarding a discussion between a pulmonary fellow and the primary team that I happened to hear while doing my usual hyponatremia consult!
Traditionally betablockers were not used in patients with COPD or asthma due to bronchospam. But using a cardioselective agent may not afect the airways.But a recent retrospective study in bmj went a step ahead and showed that it may be even beneficial in patients with COPD. 
Of nearly 6000 patients with different stages of COPD ,they found that there was a 22% reduction in all cause mortality from beta blockers. The benifit was shown across all stages of COPD. With regards to lung function, they did not affect FEV1/FVC. also betablockers seemed to have additive benifits on hospital admissions. This benifit was seen independent of presence of cardiovascular disease.


A somewhat related study published by one of my senior resident(Int J Chron Obst Pulm Disease 2010)  showed that patients with COPD may have unrecognised myocardial injury. May be betablockers help with this and this is what we are seeing here. 
Time to change practice!!