Quint, Jennifer K

J. K. Quint

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Author's reply to Wolstenholme and Sanfilippo and colleagues

LSHTM Research Online

Quint, JK (2014) Author’s reply to Wolstenholme and Sanfilippo andcolleagues. BMJ (Clinical research ed), 348. g1132. ISSN 0959-8138DOI: 10.1136/bmj.g1132Downloaded from: http://researchonline.lshtm.ac.uk/1520154/DOI: 10.1136/bmj.g1132Usage GuidelinesPlease refer to usage guidelines at http://researchonline.lshtm.ac.uk/policies.html or alterna-tively contact researchonline@lshtm.ac.uk.Available under license: Creative Commons Attribution Non-commercialhttp://creativecommons.org/licenses/by-nc/2.5/  BLOCKERS AND MORTALITY IN COPDAuthor’s reply to Wolstenholme and Sanfilippo andcolleaguesJennifer K Quint clinical lecturer and honorary consultantDepartment of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UKThe responders have highlighted some important issues thatmerit further investigation.1-4We agree with Wolstenholme that it seems counterintuitive touse β blockers and β agonists in patients with chronic obstructivepulmonary disease (COPD), but most patients in our study wereprescribed cardioselective β blockers, so theoretically β blockadewould not negate agonist activity in the lungs. Some studieshave even suggested that β blockers have beneficial effects onCOPD and reduce exacerbations and mortality independent ofcardiovascular risk.5 Although we agree that antimuscarinicagents are also effective bronchodilators, cautionmay be neededin this patient group owing to concomitant cardiac arrhythmias.This is an area in which more research is needed.As Sanfilippo and colleagues state, primary percutaneouscoronary intervention is an important and increasingly usedtreatment for ST-elevation myocardial infarction (STEMI). Ourdata (not published) suggested that patients with COPD are lesslikely than those without COPD to undergo percutaneouscoronary intervention, and in our study the number of patientsundergoing this intervention was too small to include in theanalysis. We agree that percutaneous coronary intervention isbecoming more common and may be an important factor. Weare currently undertaking a large and more up to date study ofpatients with COPD using data from the Myocardial IschemiaNational Audit Project (MINAP) to investigate this and severalother factors.Competing interests: I am the first author of the paper discussed in theresponse.1 Rutten FH, Groenwold RHH. β blockers for adults with chronic obstructive pulmonarydisease. BMJ 2013;347:f7050. (25 November.)2 Quint JK, Herrett E, Bhaskaran K, Timmis A, Hemingway H, Wedzicha JA, et al. Effectof β blockers on mortality after myocardial infarction in adults with COPD: populationbased cohort study of UK electronic healthcare records. BMJ 2013;347:f6650. (22November.)3 Sanfilippo F, Santonocito C, Foex P. Major changes in practice and interpreting data fromthe past. BMJ 2014;348:g1131.4 Wolstenholme RJ. Replacing β agonists with antimuscarinic drugs in patients with COPD.BMJ 2014;348:g1108.5 Rutten FH, Zuithoff NP, Hak E, Grobbee DE, Hoes AW. Beta-blockers may reducemortalityand risk of exacerbations in patients with chronic obstructive pulmonary disease. ArchIntern Med 2010;170:880-7.Cite this as: BMJ 2014;348:g1132© BMJ Publishing Group Ltd 2014jennifer.quint@lshtm.ac.ukFor personal use only: See rights and reprints http://www.bmj.com/permissions Subscribe: http://www.bmj.com/subscribeBMJ 2014;348:g1132 doi: 10.1136/bmj.g1132 (Published 29 January 2014) Page 1 of 1LettersLETTERS

Author's reply to Wolstenholme and Sanfilippo and colleagues.

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Author's reply to Wolstenholme and Sanfilippo and colleagues.

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