Author(s): Key A.; Parry M.; Duffy N.; Walker P.P.; Awest M.A.; Jack S.; Awest M.; Torella F.; Asher R.
Source: BMJ Open Respiratory Research; Apr 2017; vol. 4 (no. 1)
Publication Date: Apr 2017
Publication Type(s): Article
Available in full text at BMJ Open Respiratory Research – from Directory of Open Access Journals
Abstract:Introduction: beta Blockers are important treatment for ischaemic heart disease and heart failure; however, there has long been concern about their use in people with chronic obstructive pulmonary disease (COPD) due to fear of symptomatic worsening of breathlessness. Despite growing evidence of safety and efficacy, they remain underused. We examined the effect of beta-blockade on lung function, exercise performance and dynamic hyperinflation in a group of vascular surgical patients, a high proportion of who were expected to have COPD. Methods: People undergoing routine abdominal aortic aneurysm (AAA) surveillance were sequentially recruited from vascular surgery clinic. They completed plethysmographically measured lung function and incremental cardiopulmonary exercise testing with dynamic measurement of inspiratory capacity while taking and not taking beta blocker. Results: 48 participants completed tests while taking and not taking beta blockers with 38 completing all assessments successfully. 15 participants (39%) were found to have, predominantly mild and undiagnosed, COPD. People with COPD had airflow obstruction, increased airway resistance (Raw) and specific conductance (sGaw), static hyperinflation and dynamically hyperinflated during exercise. In the whole group, beta-blockade led to a small fall in FEV1 (0.1 L/ 2.8% predicted) but did not affect Raw, sGaw, static or dynamic hyperinflation. No difference in response to beta-blockade was seen in those with and without COPD. Conclusions: In people with AAA, beta-blockade has little effect on lung function and dynamic hyperinflation in those with and without COPD. In this population, the prevalence of COPD is high and consideration should be given to case finding with spirometry.Copyright © 2017, BMJ Publishing Group. All rights reserved.