Pharmacological modulation of β-adrenoceptor function in patients with coexisting chronic obstructive pulmonary disease and chronic heart failure

Pharmacological modulation of β-adrenoceptor function is one of the critical issues in the treatment of patients with concurrent chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF). A volume of published evidence sustains the role of long-acting β2-agonists in the treatment of stable COPD, but β-agonists seem to be detrimental when used for long term in CHF. β2-agonists may exacerbate heart failure and, in any case, they induce adverse cardiac effects in COPD patients with pre-existing cardiovascular disease. The adverse effects of β2-agonists are likely to be exacerbated in COPD patients with coexistent CHF. β-Blockers are the standard treatment in CHF, but they can worsen FEV1 and airway hyperresponsiveness and reluctance exists to prescribe these agents to COPD patients, despite the anticipated beneficial cardiovascular effects. Although the literature is reassuring, there are currently no prospective long-term studies on the safety of β-blockers in COPD. Therefore, although β-blockers can be introduced in any medical setting for treating patients with concurrent COPD and CHF, it still seems appropriate to only use those β-blockers that are more selective for the β1-AR but without ISA at the lowest dose and to titrate them slowly with attention to lung function and symptoms, adding an inhaled antimuscarinic agent when bronchodilation is needed.