Landmark study unveils safe beta-blocker solution for COPD patients

This breakthrough study was achieved in partnership with the University of Aberdeen. 

Bisoprolol is the most commonly used selective beta-blocker in the UK and across the globe for people with cardiac conditions like heart failure and after heart attacks. Beta-blockers work by slowing down the heart by blocking the action of hormones like adrenaline.

COPD is a common lung disease that causes airway narrowing and associated breathing problems. In people with COPD, the lungs can get damaged or clogged with mucus and this results in frequent flare ups of symptoms that usually need treatment. The use of beta-blockers to treat patients with cardiac issues and COPD has conventionally been thought to increase the risk of a COPD flare-up. This has resulted in them having been underused in treatment. 

The use of a ‘selective’ beta-blocker such as bisoprolol means that the drug can help the heart without damaging the lungs. Its high selectivity allows the drug to preferentially bind to the beta-1 receptors in the heart.

Metoprolol, the most used beta-blocker in the US, is less selective than bisoprolol and may therefore have more adverse respiratory effects by binding to beta-2 receptors in the lungs, making them potentially less suitable for COPD patients. A previous study had shown that metoprolol resulted in increased hospital admissions due to COPD. 

The Bisoprolol in COPD Study (BICS), led by Dr Brian Lipworth from Dundee’s School of Medicine, and Dr Graham Devereux, previously at the University of Aberdeen and now of the Liverpool School of Tropical Medicine, followed more than 500 patients for one year to explore the effects of bisoprolol in patients with COPD. Using the standard inhaler treatment for COPD along with addition of bisoprolol or a placebo, the study showed that there was no difference in exacerbations when treating patients associated with the beta-blocker.

Dr Lipworth said, “A series of pioneering studies performed in Tayside dating back to 1991 carefully evaluated the selectivity of beta-blockers, including bisoprolol, looking at the effects on the heart and lungs in patients with COPD and asthma.

“This research culminated in the present multicentre trial looking at effects on exacerbations in COPD. It reassuringly shows that bisoprolol is safe to use when given in addition to conventional inhaled therapy in COPD. 

“Bisoprolol should therefore not be withheld for such patients who also have heart disease where a selective beta-blocker is indicated. 

“Our results differentiate bisoprolol from metoprolol in terms of being safe to use in COPD, which is in keeping with its superior selectivity.” 

Dr Graham Devereux, BICS Co-Chief Investigator, said, “The Bisoprolol in COPD study (BICS) is important because it is the first study outside the United States to report a trial trying to treat COPD with a beta-blocker. The study shows that starting people with COPD on the highly selective beta-blocker bisoprolol does not reduce the likelihood that they will exacerbate.

“Just as importantly, BICS did not raise any of the safety concerns reported by a trial of the less selective beta-blocker metoprolol in the United States. In people with COPD, their COPD will not be improved by adding bisoprolol, equally so bisoprolol does not appear to make their COPD worse.  

“People with COPD are at increased risk of heart conditions that benefit from treatment with beta-blockers. However, there is a well-documented reluctance for physicians to prescribe beta-blockers for people with heart disease and COPD. These findings will help physicians and patients with COPD assess the risks and benefits of using bisoprolol to treat heart disease.” 

This study sheds light on the underuse of beta-blockers in COPD treatment despite their potential benefits in managing cardiovascular risks, providing valuable insights for physicians and patients navigating complex treatment decisions. 

The findings of the paper have been presented by Dr Lipworth at the American Thoracic Society’s joint AJRCCM/JAMA/NEJM Symposium in San Diego.

The project was funded by the National Institute for Health Research Health Technology Assessment (HTA) programme. The full article has been in published in the Journal of the American Medical Association.