Cardiopulmonary interactions with beta-blockers and inhaled therapy in COPD
Background
Beta-blockers remain underused in patients with chronic obstructive pulmonary disease (COPD) and cardiovascular disease.


Aim
We compared how different inhaled therapies affect tolerability of bisoprolol and carvedilol in moderate to severe COPD.


Design
A randomized, open label, cross-over study.


Methods
We compared the cardiopulmonary interactions of bisoprolol 5 mg qd or carvedilol 12.5 mg bid for 6 weeks in conjunction with: (i) triple: inhaled corticosteroid/long acting beta-agonist/long acting muscarinic antagonist (ICS + LABA + LAMA), (ii) dual: ICS + LABA and (iii) ICS alone.


Results
Eighteen patients completed, all ex-smokers, mean age 65 years, forced expiratory volume in 1 s (FEV1) 52% predicted. Bisoprolol and carvedilol produced comparable significant reduction in resting and exercise heart rate. FEV1, forced vital capacity and lung compliance (AX) were significantly lower with carvedilol vs. bisoprolol while taking concomitant ICS/LABA ( P < 0.05) but not ICS/LABA/LAMA.


Conclusions
In summary, bisoprolol was better tolerated than carvedilol on pulmonary function at doses which produced equivalent cardiac beta-1 blockade. Worsening of pulmonary function with carvedilol was mitigated by concomitant inhaled LAMA (tiotropium) with LABA (formoterol), but not LABA alone. Registered at clinicaltrials.gov: NCT01656005.