使用beta-blocker有較少的COPD住院率

以往的內科學訓練告訴我，在開beta-blocker時要注意可能有氣喘(asthma or COPD)的患者，因為會惡化疾病。這個丹麥的觀察型研究，卻告訴我們不一樣的結果。

β-Blocker Therapy and Risk of Chronic Obstructive Pulmonary Disease – A Danish Nationwide Study of 1·3 Million Individuals
Published:January 28, 2019 DOI:https://doi.org/10.1016/j.eclinm.2019.01.004

這是丹麥患者登錄系統中，追蹤了30萬位患者使用beta-blocker超過6個月和100萬位使用其他降血壓藥的患者來比較。有使用beta-blocker有較少的COPD住院率 (649 vs. 919 cases per 100,000 person-years，adjusted hazard ratio [HRadjusted] 0·80, 95% CI 0·79–0·82).

在sub-group分析發現：Risk of COPD hospitalization was lowered in the groups treated with β-blockers among patients with ischemic heart disease (0·72, 0·69–0·75), cardiac arrhythmias (0·76, 0·72–0·80), asthma (0·69, 0·61–0·79), hypertension (0·91, 0·86–0·96), and diseases of the pulmonary circulation (pulmonary embolism and cor pulmonale) (0·72, 0·59–0·87).

甚至All-cause mortality和COPD death也是有下降：in the group treated with β-blockers compared to the group treated with any other antihypertensive drugs (0·56, 0·53–0·59).

作者結論：也許我們應該要改變目前的給藥準則，在可能有COPD患者，beta-blocker不一定是絕對不能使用。