@article {1433658,
	title = {β-Blockers are associated with a reduction in COPD exacerbations},
	journal = {Thorax},
	volume = {71},
	number = {1},
	year = {2016},
	month = {2016 Jan},
	pages = {8-14},
	abstract = {BACKGROUND: While some retrospective studies have suggested that β-blocker use in patients with COPD is associated with a reduction in the frequency of acute exacerbations and lower mortality, there is concern that their use in patients with severe COPD on home oxygen may be harmful.

METHODS: Subjects with Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage 2-4 COPD participating in a prospective follow-up of the COPDGene cohort, a multicentre observational cohort of current and former smokers were recruited. Total and severe exacerbation rates were compared between groups categorised by β-blocker use on longitudinal follow-up using negative binomial regression analyses, after adjustment for demographics, airflow obstruction, \%emphysema on CT, respiratory medications, presence of coronary artery disease, congestive heart failure and coronary artery calcification, and after adjustment for propensity to prescribe β-blockers.

RESULTS: 3464 subjects were included. During a median of 2.1 years of follow-up, β-blocker use was associated with a significantly lower rate of total (incidence risk ratio (IRR) 0.73, 95\% CI 0.60 to 0.90; p=0.003) and severe exacerbations (IRR 0.67, 95\% CI 0.48 to 0.93; p=0.016). In those with GOLD stage 3 and 4 and on home oxygen, use of β-blockers was again associated with a reduction in the rate of total (IRR 0.33, 95\% CI 0.19 to 0.58; p,
	keywords = {Adrenergic beta-Antagonists, Aged, Disease Progression, Female, Follow-Up Studies, Humans, Incidence, Male, Middle Aged, Propensity Score, Prospective Studies, Pulmonary Disease, Chronic Obstructive, Radiography, Risk Factors, Severity of Illness Index},
	issn = {1468-3296},
	doi = {10.1136/thoraxjnl-2015-207251},
	author = {Bhatt, Surya P and Wells, James M and Kinney, Gregory L and Washko, George R and Budoff, Matthew and Kim, Young-Il and Bailey, William C and Nath, Hrudaya and Hokanson, John E and Silverman, Edwin K and Crapo, James and Dransfield, Mark T}
}