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Effect of β-blockade on lung function, exercise performance and dynamic hyperinflation in people with arterial vascular disease with and without COPD
  1. Angela Key1,2,
  2. Matthew Parry1,2,
  3. Malcolm A West2,3,4,
  4. Rebecca Asher5,
  5. Sandy Jack2,6,7,
  6. Nick Duffy1,2,
  7. Francesco Torella3,8 and
  8. Paul P Walker1,2,3
  1. 1Respiratory Department, Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
  2. 2Respiratory Research Group, Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
  3. 3Faculty of Health and Life Sciences, School of Physical Sciences, University of Liverpool, Liverpool, UK
  4. 4Academic Unit of Cancer Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
  5. 5Cancer Research UK Liverpool Cancer Trials Unit, University of Liverpool, Liverpool, UK
  6. 6Anaesthesia and Critical Care Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
  7. 7Integrative Physiology and Critical Illness Group, Faculty of Medicine, University of Southampton, Southampton, UK
  8. 8Liverpool Vascular and Endovascular Service, Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
  1. Correspondence to Dr Paul P Walker; ppwalker{at}liv.ac.uk

Abstract

Introduction β Blockers are important treatment for ischaemic heart disease and heart failure; however, there has long been concern about their use in people with chronic obstructive pulmonary disease (COPD) due to fear of symptomatic worsening of breathlessness. Despite growing evidence of safety and efficacy, they remain underused. We examined the effect of β-blockade on lung function, exercise performance and dynamic hyperinflation in a group of vascular surgical patients, a high proportion of who were expected to have COPD.

Methods People undergoing routine abdominal aortic aneurysm (AAA) surveillance were sequentially recruited from vascular surgery clinic. They completed plethysmographically measured lung function and incremental cardiopulmonary exercise testing with dynamic measurement of inspiratory capacity while taking and not taking β blocker.

Results 48 participants completed tests while taking and not taking β blockers with 38 completing all assessments successfully. 15 participants (39%) were found to have, predominantly mild and undiagnosed, COPD. People with COPD had airflow obstruction, increased airway resistance (Raw) and specific conductance (sGaw), static hyperinflation and dynamically hyperinflated during exercise. In the whole group, β-blockade led to a small fall in FEV1 (0.1 L/2.8% predicted) but did not affect Raw, sGaw, static or dynamic hyperinflation. No difference in response to β-blockade was seen in those with and without COPD.

Conclusions In people with AAA, β-blockade has little effect on lung function and dynamic hyperinflation in those with and without COPD. In this population, the prevalence of COPD is high and consideration should be given to case finding with spirometry.

Trial registration number NCT02106286.

  • Lung Physiology
  • Exercise
  • COPD Pharmacology

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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Footnotes

  • Contributors MAW, SJ, ND and FT contributed to study conception and design. AK, MP and MAW contributed to data acquisition. AK, MAW, RA, SJ, ND, FT and PPW contributed to data analysis and interpretation. AK and PPW contributed to manuscript drafting. AK, MP, MAW, RA, SJ, ND, FT and PPW contributed to critical manuscript revision and final manuscript approval. PPW has overall responsibility for the manuscript and is the guarantor

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval North West—Liverpool East Research and Ethics Committee (11/NW/0810).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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