Do beta-blockers worsen respiratory status for patients with COPD?
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Patients with chronic obstructive pulmonary disease (COPD) who use cardioselective beta-blockers (beta1-blockers) do not experience a significant worsening of their short-term pulmonary status as measured by changes in forced expiratory volume in 1 second (FEV1), or by changes in patients' self-reported symptoms. If such harmful effects do exist, they are likely to be less clinically important than the substantial proven benefits of beta-blockade for patients with concomitant cardiovascular disease (strength of recommendation: A, based on a high-quality meta-analysis of controlled trials). Limited evidence suggests that most patients with congestive heart failure and COPD without reversible airflow obstruction tolerate carvedilol, which causes both nonselective beta- and alpha-adrenergic blockade (SOR: B, based on limited-quality cohort studies).
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