RT Journal Article SR Electronic T1 Effect of β-blockers on the risk of COPD exacerbations according to indication of use: The Rotterdam study JF ERJ Open Research JO erjor FD European Respiratory Society SP 00624-2020 DO 10.1183/23120541.00624-2020 A1 Leila Karimi A1 Lies Lahousse A1 Phebe De Nocker A1 Bruno H. Stricker A1 Guy G. Brusselle A1 Katia M.C. Verhamme YR 2021 UL http://openres.ersjournals.com/content/early/2021/02/18/23120541.00624-2020.abstract AB Observational studies report a reduction of COPD exacerbations in patients treated with β-blockers. In contrast, the BLOCK COPD RCT which excluded COPD patients with cardiovascular (CV) conditions showed an increase in COPD exacerbations. It is unclear whether this discrepancy could be explained by underlying CV comorbidity. We examined whether the association between use of β-blockers and risk of COPD exacerbations differed between patients with and without a CV indication for β-blockers use.Within the Rotterdam Study, we followed COPD subjects until the first COPD exacerbation, or end of follow-up. Cardiovascular indication for β-blocker use was defined as a history of hypertension, coronary heart disease, atrial fibrillation, or heart failure at baseline. The association between β-blockers use and COPD exacerbations was assessed using Cox proportional hazards models adjusted for age, sex, smoking, incident CV disease (i.e., heart failure, hypertension, atrial fibrillation, and coronary heart disease during follow-up), respiratory drugs, and nitrates.In total 1312 COPD patients with a mean age=69.7±9.2 years were included. In patients with a CV indication (n=755, mean age=70.4±8.8 years), current use of cardioselective β-blockers was significantly associated with a reduced risk of COPD exacerbations (HR=0.69, 95% CI: 0.57–0.85). In contrast, in subjects without a CV indication (n=557, mean age=68.8±9.7 years), cardioselective β-blockers was not associated with an altered risk of COPD exacerbations (HR=0.94, 95% CI: 0.55–1.62).Use of cardioselective β-blockers reduced the risk of exacerbations in COPD patients with concomitant cardiovascular diseases. Therefore, the potential benefits of β-blockers might be confined to COPD patients with cardiovascular disease.FootnotesThis manuscript has recently been accepted for publication in the ERJ Open Research. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJOR online. Please open or download the PDF to view this article.Conflict of interest: Leila Karimi has nothing to disclose.Conflict of interest: Dr. Lahousse reports grants from AstraZeneca and Chiesi (both awards), and expert consultation for Boehringer Ingelheim GmbH and Novartis, outside the submitted work.Conflict of interest: Phebe De Nocker has nothing to disclose.Conflict of interest: Dr. Bruno Stricker has nothing to disclose.Conflict of interest: Dr. Brusselle reports personal fees from AstraZeneca, personal fees from Boehringer-Ingelheim, personal fees from Chiesi, personal fees from Novartis, personal fees from GlaxoSmithKline, personal fees from Sanofi, personal fees from Teva, outside the submitted work.Conflict of interest: Dr Katia Verhamme works for a research group who is the past received unconditional research grants from Pfizer, Boehringer Ingelheim, Yamanouchi, and GSK, none of them are related to the content of this paper.