Inhaled beta2-agonists and beta-blockers in patients with chronic obstructive pulmonary disease and cardiovascular comorbidities: therapeutic dilemmas, myths and realities

摘要

SUMMARY. Chronic obstructive pulmonary disease (COPD) has been shown to be associated with increased risk for cardiovascular events. The wide distribution of beta-adrenergic receptors in the respiratory and cardiovascular systems frequently discourages clinicians from using beta-blockers in patients with COPD or inhaled beta2-agonists in those with cardiovascular comorbidities. Evidence in the current literature suggests that inhaled short- and long-acting beta2-agonists can be considered safe in patients without significant cardiac disease or with clinically stable disease (arrhythmia, coronary artery disease or heart failure). In these situations COPD treatment should be initiated or adjusted rationally, provided that worsening of respiratory symptoms is not associated with decompensated heart failure or an acute coronary event. Cardioselective beta-blockers in usual doses should not be withheld from patients with COPD who have mild to severe airway obstruction, in whom their definite therapeutic benefits in the management of myocardial infarction and chronic heart failure outweigh the danger of possible induction of bronchospasm. Further research is necessary on the safety of beta-blockers in very severe stages of COPD (FEV1 30% pred.) and the use of non-cardioselective beta-blockers in subjects with partially reversible airway obstruction.