, Volume 196, Issue 1, pp 11–14 | Cite as

Tolerability of Bisoprolol on Domiciliary Spirometry in COPD



We investigated if serial domiciliary measures of spirometry were sensitive at detecting subtle effects of beta-2 blockade associated with bisoprolol in (n = 17) patients with COPD. After a two-week run in on inhaled corticosteroid (ICS) and long acting beta-2 agonist (LABA): beclometasone/formoterol 100/6 µg, patients’ started additional a long acting muscarinic receptor antagonist: (LAMA) Tiotropium 18 µg, with concomitant weekly dose titration of bisoprolol: 1.25–2.5–5 mg. After a further week of bisoprolol 5 mg, they were stepped back down to (ICS/LABA) for one week. Mean age was 64 years, mean FEV1 52% predicted, and mean FEV1/FVC ratio of 0.46. Compared to baseline am FEV1 of 1.38 L (95% CI 1.14–1.61 L), both ICS/LABA/LAMA and ICS/LABA in conjunction with bisoprolol showed statistically significant mean falls of 100 ml (1.28 L, 95% CI 1.03–1.53 L), and 120 ml, respectively (1.26 L, 95% CI 1.01–1.51 L); equalling and exceeding the MCID of 100 ml, respectively. These changes were disconnected from symptoms, reliever use and oxygen saturation.


COPD Spirometry FEV1 FEV6 Beta blocker 



The study was partially funded by TENOVUS Scotland (Grant No. T12/28) as well as from existing departmental unrestricted grant funds.

Compliance with Ethical Standards

Conflict of interest

Dr. Jabbal reports personal fees and non-financial support from Chiesi Pharma, personal fees and non-financial support from Pfizer, non-financial support and other from Napp, personal fees and non-financial support from AstraZeneca, personal fees from Boehringer Ingelheim, non-financial support from TEVA, outside the submitted work. Dr. Lipworth reports grants, personal fees and non-financial support from Chiesi, grants, personal fees, non-financial support and other from Boerhingher Ingelheim, grants and personal fees from Meda, grants, personal fees and non-financial support from Teva, grants from Janssen, grants from AstraZeneca, grants from Roche, personal fees from Dr Reddys, personal fees from Cipla, personal fees from Lupin, personal fees from Sandoz, grants from Sanofi, outside the submitted work.


  1. 1.
    Lipworth B, Skinner D, Devereux G, Thomas V, Ling Zhi Jie J, Martin J et al (2016) Underuse of beta-blockers in heart failure and chronic obstructive pulmonary disease. Heart 102(23):1909–1914CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Egred M, Shaw S, Mohammad B, Waitt P, Rodrigues E (2005) Under-use of beta-blockers in patients with ischaemic heart disease and concomitant chronic obstructive pulmonary disease. QJM 98(7):493–497CrossRefPubMedGoogle Scholar
  3. 3.
    Salpeter S, Ormiston T, Salpeter E (2005) Cardioselective beta-blockers for chronic obstructive pulmonary disease. Cochrane Database Syst Rev 19(4):Cd003566Google Scholar
  4. 4.
    Hoffmann C, Leitz MR, Oberdorf-Maass S, Lohse MJ, Klotz KN (2004) Comparative pharmacology of human beta-adrenergic receptor subtypes–characterization of stably transfected receptors in CHO cells. Naunyn-Schmiedeberg’s Arch Pharmacol 369(2):151–159CrossRefGoogle Scholar
  5. 5.
    Lipworth BJ, Irvine NA, McDevitt DG (1991) A dose-ranging study to evaluate the beta 1-adrenoceptor selectivity of bisoprolol. Eur J Clin Pharmacol 40(2):135–139PubMedGoogle Scholar
  6. 6.
    Jabbal S, Anderson W, Short P, Morrison A, Manoharan A, Lipworth BJ (2017) Cardiopulmonary interactions with beta-blockers and inhaled therapy in COPD. QJM. doi: 10.1093/qjmed/hcx155 PubMedGoogle Scholar
  7. 7.
    Swanney MP, Jensen RL, Crichton DA, Beckert LE, Cardno LA, Crapo RO (2000) FEV(6) is an acceptable surrogate for FVC in the spirometric diagnosis of airway obstruction and restriction. Am J Respir Crit Care Med 162(3 Pt 1):917–919CrossRefPubMedGoogle Scholar
  8. 8.
    Jones PW, Beeh KM, Chapman KR, Decramer M, Mahler DA, Wedzicha JA (2014) Minimal clinically important differences in pharmacological trials. Am J Respir Crit Care Med 189(3):250–255CrossRefPubMedGoogle Scholar
  9. 9.
    Jensen MT, Marott JL, Lange P, Vestbo J, Schnohr P, Nielsen OW et al (2013) Resting heart rate is a predictor of mortality in COPD. Eur Respir J 42(2):341–349CrossRefPubMedGoogle Scholar
  10. 10.
    Baker JG (2005) The selectivity of beta-adrenoceptor antagonists at the human beta1, beta2 and beta3 adrenoceptors. Br J Pharmacol 144(3):317–322CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Lipworth BJ, Brown RA, McDevitt DG (1989) Assessment of airways, tremor and chronotropic responses to inhaled salbutamol in the quantification of beta 2-adrenoceptor blockade. Br J Clin Pharmacol 28(1):95–102CrossRefPubMedPubMedCentralGoogle Scholar

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© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  1. 1.Scottish Centre for Respiratory Research, Division of Molecular and Clinical MedicineNinewells Hospital and Medical SchoolDundeeUK

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