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Abstract

Coronary atherosclerosis and chronic obstructive pulmonary disease (COPD) are
highly prevalent, and two of the commonest causes of morbidity and mortality in the
Australian population. They share cigarette smoking as an important risk factor, and
frequently coexist. Drugs which act on the beta-adrenergic receptor are important
therapeutic tools in both diseases. However, beta-receptor antagonists, which are
commonly used to treat cardiac disease, theoretically may cause adverse respiratory
effects and are traditionally avoided in patients with obstructive airways disease.
This work seeks to explore the short and longer term effects of beta-blocker
medications, when used for treatment of cardiac disease in patients with coexisting
obstructive airways disease. Specifically, the aims of this research are:
1. To estimate the prevalence of coexisting obstructive airways disease amongst
patients with cardiac disease
2. To investigate current beta-blocker prescribing practice in patients with
obstructive airways disease
3. To document adverse respiratory effects of beta-blocker medications, in
terms of symptoms, lung function and other longer term health outcomes.
Within 24 hours of hospital admission for suspected cardiac disease, patients were
screened for airways obstruction, using spirometry. Spirometry results demonstrated
a high level of coexistence of cardiac disease and obstructive airways disease, about
twice that cited in previously published estimates. Documentation of beta-blocker prescribing practices within the Royal Prince Alfred Hospital’s Cardiology Unit
revealed minimal prescription of these medications to patients with previously
diagnosed chronic obstructive airways disease and asthma, despite limited evidence
of adverse effects of beta-blocker use in such patients. This notably occurred even
when guidelines recommended beta-blockade as first line therapy, and where
survival benefit was established. However, many patients with obstructive
spirometry, but no formal diagnosis of obstructive airways disease, did receive betablockers.
Longitudinal analysis of symptom assessment, lung function and health
outcomes was performed. Lung function and respiratory symptoms data were
collected over a twelve month period and data pertaining to beta-blocker
discontinuation, respiratory exacerbations, acute cardiac events and survival were
collected over almost six years. There was no indication of a statistically significant
adverse beta-blocker effect on lung function, respiratory symptoms or survival but
beta-blocker medications did appear to increase respiratory exacerbation rates.
This work confirms the very high frequency of obstructive airways disease existing
in combination with cardiac disease in an Australian urban population, which had
been suspected but not previously documented. However, its major contribution is to
provide prospective long term respiratory health outcome data for the use of betablocker
medications in this group.

Item Type:	Thesis - PhD
Authors/Creators:	Cochrane, B
Keywords:	Beta-blockers, obstructive airways disease, COPD, adverse effects
Additional Information:	Copyright 2010 the Author
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