Metoprolol is not effective for preventing acute exacerbations in COPD

Dransfield MT, Voelker H, Bhatt SP, et al. Metoprolol for the prevention of acute exacerbations of COPD. N Engl J Med 2019;20;380 25):2429–39.

Results of observational studies suggest that beta-blockers have a role in preventing acute exacerbations of COPD, however a recent randomised controlled trial demonstrates it may cause more harm than good.

Acute exacerbations of chronic obstructive pulmonary disease (COPD) are a major contributor to morbidity and mortality. Reductions in the frequency and severity of such exacerbations improve long-term clinical outcomes and quality of life.1 Previous meta-analyses of observational studies have suggested that beta- blockers may be beneficial in the management of COPD.

The BLOCK COPD (Beta-Blockers for the Prevention of Acute Exacerbations of COPD) study was a multicentre, randomised, placebo-controlled clinical trial (n=532) that assessed the effectiveness of extended-release metoprolol (a beta-1 selective adrenergic receptor blocker) in preventing acute exacerbations in adults with moderate or severe COPD (aged 40–85 years).4

The primary outcome was time until first exacerbation. Secondary outcomes included hospitalisations, adverse events and quality of life (measured by the St George’s Respiratory Questionnaire and the COPD Assessment Test).

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