Beta-blocker use in heart failure patients with airways disease.

Background: Beta-Blockers are often withheld from patients with obstructive airways disease, especially those with reversible airways disease due to fear of inducing bronchospasm. We report our single center experience of cautiously treating such patients who have concomitant chronic heart failure (CHF).
Hypothesis: The use of cardioselective beta-blockers under caution and specialist supervision may be tolerable in many CHF patients with obstructive airways disease, resulting in clinical improvement rather than detriment.
Methods: A retrospective case notes analysis was performed on CHF outpatients who had obstructive airways disease and been treated with beta-blockers.
Results: A total of 43 patients were identified, with an average ejection fraction of 31.8%; 18 of these patients had fixed obstructive airways disease, 15 patients had reversible obstructive airways disease, 10 patients had a label of obstructive airways disease (but no supporting evidence for the diagnosis in the hospital notes). In all 3 groups, beta-blockers had been initiated and maintained without any respiratory event over a median continuous exposure time of 135 days. Limitation of the dose was documented in only 2 patients because of worsening shortness of breath. New York Heart Association (NYHA) class significantly improved for the group with the use of these agents (p = 0.003).
Conclusion: A cautious approach (under specialist supervision) to beta-blocker use in patients with heart failure and airways disease can result in successful treatment. The implications of withholding these agents may have more serious consequences than their administration.