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β-Blocker use and incidence of chronic obstructive pulmonary disease exacerbations.
Ann Pharmacother 2013; 47(5):651-6AP

Abstract

BACKGROUND

β-Adrenergic antagonist (β-blocker) use in patients with chronic obstructive pulmonary disease (COPD) has been avoided as a result of potential risk of pulmonary adverse effects. However, recent studies indicate that β-blocker use in patients with COPD can decrease outpatient visits and either decrease or have no effect on the number of hospitalizations. Long-term treatment with β-blockers has been shown to increase survival and decrease exacerbations in patients with COPD.

OBJECTIVE

To assess the impact of β-blocker use on the incidence of exacerbations in patients with COPD.

METHODS

In a retrospective cohort study of patients with COPD from 2 academic primary care practice sites who were seen in 2010, patients were identified using International Classification of Diseases, 9th revision, Clinical Modification codes for COPD and reviewing active medication lists for COPD-specific medications (tiotropium). Patients were classified as either a β-blocker user or a nonuser. Primary outcomes were incidence and severity of COPD exacerbations. Secondary outcomes included COPD exacerbations distinguished by β-blocker cardioselectivity and all-cause hospitalizations.

RESULTS

The study enrolled 412 patients. Of those, 166 patients were β-blocker users and 246 were β-blocker nonusers. β-Blocker users were less likely to have a COPD exacerbation (OR 0.61, 95% CI 0.40-0.93) and had fewer mild exacerbations (OR 0.56; 95% CI 0.34-0.89). There was no significant difference in COPD exacerbations based on β-blocker cardioselectivity (OR 0.84, 95% CI 0.38-1.83). When controlled for, using a backwards stepwise logistic regression, β-blocker use was a variable in the model that predicted exacerbations but alone was not statistically significant (adjusted OR 0.62, 95% CI 0.39-1.01).

CONCLUSIONS

Patients with COPD prescribed a β-blocker were significantly less likely to have a COPD exacerbation and had fewer mild COPD exacerbations.

Authors+Show Affiliations

University of Tennessee Health Science Center, College of Pharmacy, Knoxville, Tennessee, USA. mfarland@uthsc.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

23585645

Citation

Farland, Michelle Z., et al. "Β-Blocker Use and Incidence of Chronic Obstructive Pulmonary Disease Exacerbations." The Annals of Pharmacotherapy, vol. 47, no. 5, 2013, pp. 651-6.
Farland MZ, Peters CJ, Williams JD, et al. Β-Blocker use and incidence of chronic obstructive pulmonary disease exacerbations. Ann Pharmacother. 2013;47(5):651-6.
Farland, M. Z., Peters, C. J., Williams, J. D., Bielak, K. M., Heidel, R. E., & Ray, S. M. (2013). Β-Blocker use and incidence of chronic obstructive pulmonary disease exacerbations. The Annals of Pharmacotherapy, 47(5), pp. 651-6. doi:10.1345/aph.1R600.
Farland MZ, et al. Β-Blocker Use and Incidence of Chronic Obstructive Pulmonary Disease Exacerbations. Ann Pharmacother. 2013;47(5):651-6. PubMed PMID: 23585645.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - β-Blocker use and incidence of chronic obstructive pulmonary disease exacerbations. AU - Farland,Michelle Z, AU - Peters,Cassey J, AU - Williams,Juli D, AU - Bielak,Kenneth M, AU - Heidel,R Eric, AU - Ray,Shaunta' M, Y1 - 2013/04/12/ PY - 2013/4/16/entrez PY - 2013/4/16/pubmed PY - 2013/11/19/medline SP - 651 EP - 6 JF - The Annals of pharmacotherapy JO - Ann Pharmacother VL - 47 IS - 5 N2 - BACKGROUND: β-Adrenergic antagonist (β-blocker) use in patients with chronic obstructive pulmonary disease (COPD) has been avoided as a result of potential risk of pulmonary adverse effects. However, recent studies indicate that β-blocker use in patients with COPD can decrease outpatient visits and either decrease or have no effect on the number of hospitalizations. Long-term treatment with β-blockers has been shown to increase survival and decrease exacerbations in patients with COPD. OBJECTIVE: To assess the impact of β-blocker use on the incidence of exacerbations in patients with COPD. METHODS: In a retrospective cohort study of patients with COPD from 2 academic primary care practice sites who were seen in 2010, patients were identified using International Classification of Diseases, 9th revision, Clinical Modification codes for COPD and reviewing active medication lists for COPD-specific medications (tiotropium). Patients were classified as either a β-blocker user or a nonuser. Primary outcomes were incidence and severity of COPD exacerbations. Secondary outcomes included COPD exacerbations distinguished by β-blocker cardioselectivity and all-cause hospitalizations. RESULTS: The study enrolled 412 patients. Of those, 166 patients were β-blocker users and 246 were β-blocker nonusers. β-Blocker users were less likely to have a COPD exacerbation (OR 0.61, 95% CI 0.40-0.93) and had fewer mild exacerbations (OR 0.56; 95% CI 0.34-0.89). There was no significant difference in COPD exacerbations based on β-blocker cardioselectivity (OR 0.84, 95% CI 0.38-1.83). When controlled for, using a backwards stepwise logistic regression, β-blocker use was a variable in the model that predicted exacerbations but alone was not statistically significant (adjusted OR 0.62, 95% CI 0.39-1.01). CONCLUSIONS: Patients with COPD prescribed a β-blocker were significantly less likely to have a COPD exacerbation and had fewer mild COPD exacerbations. SN - 1542-6270 UR - https://www.unboundmedicine.com/medline/citation/23585645/β_Blocker_use_and_incidence_of_chronic_obstructive_pulmonary_disease_exacerbations_ L2 - http://journals.sagepub.com/doi/full/10.1345/aph.1R600?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -