skip to main content

Beta-blocker Selection in COPD — EECC MCQ

Instant feedback + full explanation. One question, done properly.

ModerateCardiac PharmacologyBeta-blocker Selection in COPDEECC

A 65-year-old man with HFrEF on carvedilol 25 mg bd, sacubitril/valsartan 49/51 mg bd, eplerenone 50 mg, and dapagliflozin 10 mg develops severe COPD exacerbation. His respiratory physician asks whether carvedilol should be switched to a beta-1 selective agent. What is the recommendation?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — Bisoprolol (beta-1 selective) is preferred over carvedilol (non-selective) in patients with significant airways disease, though both are Class I HF medications; the switch should be done carefully without abrupt withdrawal

Three beta-blockers have mortality evidence in HFrEF: bisoprolol (beta-1 selective), carvedilol (non-selective alpha/beta), and metoprolol succinate CR/XL (beta-1 selective). In patients with significant obstructive airways disease, beta-1 selective agents (bisoprolol, metoprolol succinate) are preferred over carvedilol because beta-2 blockade can worsen bronchospasm. However, even beta-1 selective agents may have some beta-2 activity at higher doses. The ESC HF Guidelines recommend that beta-blockers should not be withheld in HFrEF patients with mild-moderate COPD (Class IIa), as the mortality benefit outweighs the respiratory risk. In severe COPD/asthma, careful titration of a beta-1 selective agent with monitoring of lung function is recommended.

Reference: ESC (2023): Focused Update on Heart Failure; NICE COPD Guidelines