Безопасность бетаблокаторов при обструктивных заболеваниях лёгких

[Alexey2301]

Уважаемые коллеги! Помогите пожалуйста в поиске информации по данной теме.

[Dr.Vad]

Похоже, давно пора забыть про опасность-безопасность ББ при ХОБЛ, имеющийся эвиденс говорит о снижении риска смерти на фоне их приема в этой категории пациентов:

BMC Pulm Med. 2012 Sep 4;12:48. doi: 10.1186/1471-2466-12-48.
Beta-blocker use and COPD mortality: a systematic review and meta-analysis.

The pooled relative risk of COPD related mortality secondary to beta-blocker use was 0.69 (95% CI: 0.62-0.78; I2=82%)... The results of this review are consistent with a protective effect of beta-blockers with respect to all cause mortality.

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[Alexey2301]

Вадим Валерьевич, спасибо Вам большое!

[Gilarov]

Тем не менее, вполне возможно усиление бронхиальной обструкции при использовании больших доз бета-блоков. Т. е. Требуется определенная осторожность.

[Dr.Vad]

так и есть: большие дозы (например метопролол более 100 мг) могут усугублять течение астмы:

We searched the English literature from 1976 to 2011 via PubMed, EMBASE, and SCOPUS using the following search terms: "beta-blocker treatment of hypertension" AND "asthma"; "cardioselective beta-blockers" AND "asthma." When pertinent articles were found, we assessed relevant articles cited in those papers. All studies related to cardioselective beta-blocker use in patients with asthma and hypertension were included.
RESULTS: Seven studies with patient populations ranging from 10 to 17 patients evaluated cardioselective beta-blockers in patients with asthma and hypertension. Atenolol and/or immediate-release metoprolol were evaluated in these studies. The duration of beta-blocker therapy in four studies was 1-8 weeks; two studies were single dose and one investigation lasted 8 months. Metoprolol and atenolol were generally well tolerated except at higher doses such as metoprolol >100 mg daily.

J Asthma. 2012 Nov;49(9):947-51. Cardioselective beta-blocker treatment of hypertension in patients with asthma: when do benefits outweigh risks?

[Dr.Vad]

В целом же, у пациентов с ХОБЛ на бета-блокаторах риск ухудшения ситуации с осн. заболеванием сравнительно ниже:

The study enrolled 412 patients. Of those, 166 patients were β-blocker users and 246 were β-blocker nonusers. β-Blocker users were less likely to have a COPD exacerbation (OR 0.61, 95% CI 0.40-0.93) and had fewer mild exacerbations (OR 0.56; 95% CI 0.34-0.89). There was no significant difference in COPD exacerbations based on β-blocker cardioselectivity (OR 0.84, 95% CI 0.38-1.83). When controlled for, using a backwards stepwise logistic regression, β-blocker use was a variable in the model that predicted exacerbations but alone was not statistically significant (adjusted OR 0.62, 95% CI 0.39-1.01).
Patients with COPD prescribed a β-blocker were significantly less likely to have a COPD exacerbation and had fewer mild COPD exacerbations.

Ann Pharmacother. 2013 May;47(5):651-6.
β-Blocker Use and Incidence of Chronic Obstructive Pulmonary Disease Exacerbations.