Bisoprolol in patients with heart failure and moderate to severe chronic obstructive pulmonary disease: a randomized controlled trial

Aims Heart failure (HF) and chronic obstructive pulmonary disease (COPD) frequently coexist. No study has prospectively examined the effects of beta-blockade in those with both conditions. Methods and results We randomized 27 patients with HF and coexistent moderate or severe COPD to receive bisoprolol or placebo, titrated to maximum tolerated dose over 4 months. The primary outcome was forced expiratory volume in 1 s (FEV1). The study is registered with ClinicalTrials.gov, number: NCT00702156. Patients were elderly and predominantly male. Cardiovascular comorbidity, smoking history, and pulmonary function were similar in each group (mean FEV1 1.37 vs. 1.26 L, P = 0.52). A reduction in FEV1 occurred after 4 months following treatment with bisoprolol compared with placebo (−70 vs. +120 mL, P = 0.01). Reversibility following inhaled β2-agonist and static lung volumes were not impaired by bisoprolol. All measures of health status exhibited a consistent non-significant improvement, including the Short Form 36 physical and mental component scores (2.6 vs. 0.5 and 0.8 vs. −0.3, respectively), Minnesota Living with Heart Failure Questionnaire (−2.5 vs. 3.5) and Chronic Respiratory Questionnaire (0.07 vs. −0.24). The mean number of COPD exacerbations was similar in the bisoprolol and placebo groups (0.50 and 0.31, respectively, P = 0.44). Conclusion Initiation of bisoprolol in patients with HF and concomitant moderate or severe COPD resulted in a reduction in FEV1. However, symptoms and quality of life were not impaired.