Journal of Clinical and Bioanalytical Chemistry

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Editorial - Journal of Clinical and Bioanalytical Chemistry (2017) Volume 1, Issue 1

How can low dose selective beta receptor blocker affect AECOPD patients with core pulmonale

Ahmed Amin*

Department of Clinical Pharmacy, Kafrelsheikh University, Egypt

*Corresponding Author:
Ahmed Amin
Department of Clinical Pharmacy
Kafrelsheikh University
Egypt
Tel:
013-2757990
E-mail:
[email protected]

Accepted Date: August 18, 2017

Citation: Ahmed Amin. How can low dose selective beta receptor blocker affect AECOPD patients with core pulmonale.. J Clin Bioanal Chem 2017;1(1):1.

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Abstract

Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death and is estimated to rise to be the third most common cause of death worldwide by 2020. Many patients with COPD have concomitant conditions, mostly coronary artery disease (CAD) that requires the use of betablockers (BBs). However, despite the clear evidence of BBs effectiveness, there is a general reluctance to use them in patients with COPD due to a perceived contraindication and fear of inducing adverse reactions and bronchospasm.

Introduction

Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death and is estimated to rise to be the third most common cause of death worldwide by 2020 [1]. Many patients with COPD have concomitant conditions, mostly coronary artery disease (CAD) that requires the use of betablockers (BBs). However, despite the clear evidence of BBs effectiveness, there is a general reluctance to use them in patients with COPD due to a perceived contraindication and fear of inducing adverse reactions and bronchospasm [2].

Currently, β-adrenergic antagonists (β-blockers) are underused in patients with COPD for the perceived risk of bronchoconstriction [3-5]. In a study by Dransfield et al., only 31% of patients with COPD and an indication for a β-blocker (e.g., myocardial infarction or congestive heart failure) received a β-blocker [6]. Multiple studies have shown that use of β-blockers (especially cardio-selective β-blockers) is safe in patients with COPD and decreases mortality in patients with coronary vascular disease [6].

The in-depth study by He et al. [7] in this issue of Journal of Clinical and Bio analytical Chemistry sheds some light on the subject. Using a prospective randomized placebo controlled study design, 100 patients with both COPD and right-sided heart failure (core pulmonale) and with a heart rate>100 beats/min were included in this clinical study. 50 patients were assigned to beta blocker, metoprolol tartrate tablets (experimental) group and 50 patients to placebo group. The study revealed a significant reduction in heart rate in the experimental group, the results which were expected as beta blockers decrease heart rate.

The frequency of acute exacerbation per year was calculated in this study which was significantly lower in the experimental group, compared with the control group. This result was described by Farland et al. [8] who added that BBs not only decrease exacerbation and mortality in COPD patients with cardio-vascular disease, but also in COPD patients without cardio-vascular disease.

No statistically significant difference was noted in terms of the FEV1 between the two studied groups in this study. The effect of cardio-selective beta-blockers on respiratory function was evaluated in two meta-analyses, which showed similar efficacy as this study, [9] one in patients with mild to moderate reactive airway disease, the other in patients with mild to severe COPD. The results from those two meta-analyses led the authors to conclude that cardio-selective beta-blockers do not cause a significant reduction in pulmonary function in patients with mild to moderate reactive airway disease and COPD and are therefore safe to use.

The authors of the current study examined the effect of selective beta receptor blocker on the mortality rate and recorded reduction in experimental group over controls one. These results agree with previous study by Salpeter et al. [10] reported that Patients with COPD or asthma who were not on beta-agonist had lower one-year mortality if they were on BBs9.

Although the authors of the current study examined the effect of low dose selective beta receptor blocker on AECOPD patients with core pulmonale in a small number of patients (100 patients), it could be a pilot study however, we need further studies with larger numbers of patients to confirm the results of the current study.

References