β-Blockers in COPD A Cohort Study From the TONADO Research Program

BACKGROUND: Cardiovascular disease is a frequent comorbidity in patients with COPD. Many physicians, particularly pulmonologists, are reluctant to use beta-adrenoceptor blocking agents (beta-blockers) in patients with COPD, despite their proven effectiveness in preventing cardiovascular events. METHODS: The large (5,162 patients) phase III TONADO 1 and 2 studies assessed lung function and patient-reported outcomes in patients with moderate to very severe COPD receiving long-acting bronchodilator treatment across 1 year. This post hoc analysis characterized lung-function changes, patient-reported outcomes, and safety in the subgroup of patients receiving b-blockers in the studies. RESULTS: In total, 557 of 5,162 patients (11%) received beta-blockers at baseline. Post-bronchodilator FEV1 at baseline was higher in the beta-blocker group (1.470 L) compared with that in the no beta-blocker group (1.362 L). As expected, patients receiving beta-blockers had a more frequent history of cardiovascular comorbidities and medications. Lung function improved from baseline in patients with or those without beta-blocker treatment, and no relevant between-group differences were observed in trough FEV1 or trough FVC at 24 or 52 weeks. No relevant differences were observed for St. George's Respiratory Questionnaire results and Transition Dyspnea Index in patients with beta-blockers compared with those in patients without. Safety findings were comparable between groups. CONCLUSIONS: Lung function, overall respiratory status, and safety of tiotropium/olodaterol were not influenced by baseline beta-blocker treatment in patients with moderate to very severe COPD. Results from this large patient cohort support the cautious and appropriate use of beta-blockers in patients with COPD and cardiovascular comorbidity.