Volume 27, Issue 5 p. 684-690

Rates of Hospitalizations and Emergency Department Visits in Patients with Asthma and Chronic Obstructive Pulmonary Disease Taking β-Blockers

Dr. Tyson W. A. Brooks Pharm.D.

Corresponding Author

Dr. Tyson W. A. Brooks Pharm.D.

St. Louis College of Pharmacy, St. Louis, Missouri

St. Louis College of Pharmacy, 4588 Parkview Place, St. Louis, MO 63110; e-mail: [email protected].Search for more papers by this author
Dr. Freddy M. Creekmore Pharm.D.

Dr. Freddy M. Creekmore Pharm.D.

College of Pharmacy, University of Utah, Salt Lake City, Utah

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Dr. David C. Young Pharm.D.

Dr. David C. Young Pharm.D.

College of Pharmacy, University of Utah, Salt Lake City, Utah

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Dr. Carl V. Asche Ph.D.

Dr. Carl V. Asche Ph.D.

College of Pharmacy, University of Utah, Salt Lake City, Utah

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Mr. Brian Oberg M.B.A.

Mr. Brian Oberg M.B.A.

College of Pharmacy, University of Utah, Salt Lake City, Utah

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Dr. Wayne M. Samuelson M.D.

Dr. Wayne M. Samuelson M.D.

Pulmonary Division, School of Medicine, University of Utah, Salt Lake City, Utah.

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First published: 06 January 2012
Citations: 33

Abstract

Study Objective. To determine the rates of hospitalizations and emergency department (ED) visits during cardioselective and nonselective β-blocker therapy in patients with asthma and/or chronic obstructive pulmonary disease (COPD).

Design. Retrospective, observational cohort study.

Data Source. Electronic medical records database.

Patients. A total of 11,592 adult patients with asthma and/or COPD, identified from August 1, 1997-December 31, 2005, who were taking β-blockers for at least 30 days or had never received a β-blocker (controls).

Measurements and Main Results. Of these patients, 3062 were taking cardioselective and 690 nonselective β-blockers; 7840 were controls. The primary end point for the β-blocker groups was the rate of hospitalizations and ED visits/patient-year of β-blocker therapy relative to the control group. In patients with asthma with or without concomitant COPD, cardioselective β-blockers were associated with a relative risk of 0.89 (95% confidence interval [CI] 0.53-1.50) for hospitalizations and 1.40 (95% CI 1.20-1.62) for ED visits compared with controls. Nonselective β-blockers were associated with a relative risk of 2.47 (95% CI 1.37-4.48) for hospitalizations and 1.21 (95% CI 0.91-1.62) for ED visits. In patients with COPD only, cardioselective β-blockers were associated with a relative risk of 0.64 (95% CI 0.43-0.96) for hospitalizations and 1.19 (95% CI 1.02-1.39) for ED visits. Nonselective β-blockers were associated with a relative risk of 1.02 (95% CI 0.52-2.02) for hospitalizations and 0.51 (95% CI 0.33-0.80) for ED visits.

Conclusion. In patients with asthma with or without COPD, both cardioselective and nonselective β-blocker use increased hospitalizations and ED visits compared with controls. Thus, these patients should receive β-blocker therapy only if their cardiac risk exceeds their pulmonary risk and if they have concomitant cardiac disease for which β-blockers decrease mortality, such as previous acute myocardial infarction or chronic heart failure. In patients with COPD only, cardioselective β-blockers slightly increased the risk of ED visits but reduced the risk of hospitalizations. Nonselective β-blocker therapy in these patients reduced the rate of ED visits and total visits. These findings suggest a larger safety margin with β-blocker therapy in patients with COPD only than in those with asthma with or without COPD.