Is it OK to give cardioselective beta blockers to patients with COPD?

This Cochrane review, which looked at studies using single doses or longer durations of administration, says yes. The beta blockers did not affect the patients’ symptoms, spirometry measurements or their response to bronchodilators.

Examples of cardioselective beta blockers include atenolol, metoprolol, esmolol, bisoprolol and acebutolol. Propranolol, timolol, carvedilol, labetalol and sotolol are non-selective beta blockers.

As I posted previously there is considerable overlap between COPD and cardiovascular disease so that many patients with COPD could obtain cardiovascular benefits from beta blockers. This review suggests that we should not consider them contraindicated in patients who need them for cardiovascular disease. I would caution that cardioselectivity is not absolute, and cardiovascular benefit is often obtained at higher dose ranges in which selectivity is lost. These conclusions should not be applied to patients with asthma.