Abstract
Williams and Oakeshott caution against the use of the β blocker bisoprolol for chronic heart failure in patients with severe asthma or chronic obstructive pulmonary disease (COPD).1 This recommendation is somewhat contentious. Patients with COPD often have cardiac comorbidities, including chronic heart failure (~20% of patients2), and in one large study of patients with COPD, 27% of deaths were attributable to cardiac causes.3 Selective β blockers such as bisoprolol have been shown to be safe in COPD.4 5 Moreover, in addition to the beneficial effects on outcomes relating to heart failure, there is mounting evidence that β blockade may also improve outcomes from COPD.6