Lots of people have both heart failure and COPD or asthma. Should you be concerned that the beta-blocker they’re on will make them more likely to have a COPD flare?

The short answer is: no. A review by Abouaini et al in 2007 reports that beta-blocker use is well-tolerated in COPD patients and does not worsen respiratory symptoms or worsen FEV1. The fears that beta-blockers may aggravate bronchospasm is based on case reports/anecdotes. That being said, it’s safer to start a patient with COPD on a cardioselective beta-blocker like metoprolol. Carvedilol (non-selective) is also okay if the patient has severe heart failure, though.

NB: Try to look for evidence that your patient has COPD, such as PFTs or characteristic findings on x-ray or exam. Too often, older adults get diagnosed with COPD when they have dyspnea and wheezing “just because.”