Chronic obstructive pulmonary disease (COPD) recently surpassed stroke as the 3rd leading cause of death in the United States and accounts for more than $40 billion annually in direct and indirect health care costs.  Though existing pharmacotherapy can improve symptoms, quality of life and modestly reduce the risk of acute exacerbations, no treatments alter the natural history of the disease or improve mortality.  COPD is also associated with an increased risk of a number of major comorbid illnesses, most importantly cardiovascular disease.  Despite clear evidence that beta-blockers markedly reduce cardiovascular risk in patients with COPD, concerns regarding their potential adverse respiratory effects have led to their dramatic underuse.  This practice pattern persists despite recent observational data suggesting that beta-blockers may also reduce acute exacerbations of the disease. These data require validation and thus the proposed clinical trial of beta-blockers to prevent exacerbations of COPD addresses the most important chronic lower respiratory tract illness in the United States, will test the efficacy of a novel approach to prevent its most morbid and costly consequences, and will provide critical information to shape guideline recommendations regarding the management of patients with co-morbid cardiovascular disease.

Impact and Military Relevance

COPD affects approximately 6% of civilians and at least 8% of the Veteran population though the prevalence is increasing in both groups and when Veterans with respiratory complaints are evaluated with spirometry and questionnaires rates of COPD may be as high as 43%.  Veterans with COPD also account for significantly higher all-cause and respiratory-related inpatient and outpatient health care utilization than those without COPD. Successful completion of the proposed project will have immediate clinical impact on the care of current and future Veterans with COPD as well as the broader civilian population.  No matter the results of the trial, data derived will inform public health policy and shape guideline recommendations regarding the appropriate use of beta-blockers in patients with COPD including those with and without underlying cardiovascular disease.  If positive, the trial will also provide a novel approach for the prevention of COPD exacerbations which drive the morbidity and mortality of this chronic disabling disease.