Most of us are aware of the medical leaflet warning that beta blockers in bronchospastic disease should be avoided or at least be given with great caution due to the risk of increased airway resistance. An interesting question therefore is, whether beta blockers prescribed in COPD patients with acute myocardial infarction (AMI) also benefit of their effect and if this also affects survival.
Quint et al. have looked into this topic by performing a retrospective study including 1063 COPD patients, who experienced their first AMI. 55.1% of these patients were never prescribed a beta blocker throughout the study period, 23% were on beta blockers before and 21.9% were prescribed a beta blocker during their hospital admission for AMI.
Patients started on beta blocker during their hospital admission showed substantial survival benefits compared to patients who were not prescribed any beta blockers. Patients taking beta blockers before their first myocardial infarction also showed a substantial survival benefit!
Taking into the account these results and the increasing evidence that beta blocker are actually safe in COPD patients suggests that beta blockers should be used more widely in patients at risk for AMI.
At least we should not be too worried to prescribe them.
Quint J K et al. BMJ 2013;347:f6650
Dransfield M T et al. Torax 2008;63:301-305