Use of β-Adrenoceptor Antagonists in Older Patients with Chronic Obstructive Pulmonary Disease and Cardiovascular Co-Morbidity

The incidence of and mortality from both chronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD) increase with age. In addition, the average age of patients with COPD and CVD is also increasing as a result of improvements in both pharmacological and non-pharmacological treatments. Coronary artery disease is a compelling indication for β-adrenoceptor antagonist use in a population in whom β-adrenoceptor antagonism is often viewed as contraindicated. β-Adrenoceptor antagonists have been proven to improve cardiovascular morbidity and mortality but have been under-utilized in patients with COPD with concomitant CVD because of a fear of bronchoconstriction and adverse effects, particularly in the elderly. The advanced age of patients with COPD and CVD, along with the sheer number of patients with these diseases, necessitates that clinicians understand the treatment of these co-morbidities using seemingly conflicting therapy in the form of β-adrenoceptor agonists and antagonists.

We review changes in the pharmacokinetics and pharmacodynamics of β-adrenoceptor antagonists in the elderly, the role of β-adrenoceptor antagonists in CVD and the literature regarding the safety and mortality benefits of β-adrenoceptor antagonists in elderly patients with COPD and concomitant CVD. We conclude that cardioselective β-adrenoceptor antagonists appear to be safe to use in elderly male patients with mild-to-moderate COPD who have a compelling indication for β-adrenoceptor antagonist therapy. Data in female patients are very limited. Nonselective β-adrenoceptor antagonists should be avoided in general, except in patients with heart failure who might benefit significantly from the use of carvedilol. β-Adrenoceptor antagonists have been shown to improve mortality in older patients with coexisting CVD and COPD.