None listed
Conditions
Brief summary
Cardiovascular comorbidity is common in patients with COPD. They share cigarette smoking as an important risk factor. However, beta blockers, which are commonly used to treat cardiac diseases, are traditionally avoided in patients with COPD due to the theoretical risk of respiratory adverse events. The aims of this study are: 1. To assess the safety of commencing beta blockers during an acute exacerbation of COPD in individuals with coexistent cardiovascular disease. 2. To assess the impact of commencement of beta blockers on lung function as measure by post bronchodilator spirometry in patients admitted for exacerbation of COPD. This is a prospective interventional study of individuals admitted with exacerbations of COPD conducted in two metropolitan hospitals in Melbourne. Individuals who are admitted to the Northern and Austin Hospital with acute exacerbations of COPD who have a history of COPD (GOLD Class II – III) and of cardiovascular disease will be invited to participate in the study. When they are considered stable and suitable for participation, the treating team will notify the study coordinator who will consent and enroll the individual in the study. After signing of the informed consent form, participants who are identified to be ready for discharge the following day will perform spirometry. An initial dose of a cardio-selective beta blocker will be administered and spirometry will be repeated. Unless an adverse event has occurred, beta blocker administration will continue on the day of discharge, with spirometry repeated. Participants will be reviewed at 21-days post discharge with repeat spirometry. This will be carried out in the Respiratory Outpatient Clinic as is standard practice.
Interventions
All COPD patients who fulfil the inclusion criteria will be given oral metoprolol (ATC C07A B02) 25mg daily for 21 days.
Patients will be assessed on Day 0, 1 and 21 for any side effects from oral metoprolol as well as the effect of metoprolol on spirometry.
Sponsors
Northern Hospital
Study design
Allocation
Non-randomised trial
Primary purpose
Treatment
Eligibility
Sex/Gender
All
Age
18 Years to 85 Years
Healthy volunteers
No
Inclusion criteria
- Age over 18 years - Primary admission diagnosis of acute exacerbation of COPD - Moderate to severe COPD (GOLD Class II – III) as defined by spirometry performed prior to admission - Co-existing cardiovascular diseases with Class I indications, such as IHD, HTN and HFrEF for which beta blocker therapy is indicated.
Exclusion criteria
- Unwilling to consent - History of other primary lung disease including asthma, and interstitial lung disease - Baseline FEV1/FVC greater than 0.7 - Very severe COPD (GOLD IV) - Illness severity, sufficient to preclude informed consent or completion of the study protocol. Subjects are also excluded if enrolment in the study protocol was likely to interfere with timely medical investigation and treatment - Severe cognitive impairment - Physical impairment or social circumstances that would prevent follow up assessments - Patients with beta blocker allergy or previous documented reactions - Any degree of heart block - Already taking a beta blocker or other anti-arrhythmic including calcium channel blocker
Outcome results
None listed