CHRONIC obstructive pulmonary disease (COPD) is a long-term lung condition characterised by persistent breathlessness, airflow limitation, and recurrent flare-ups, most often linked to smoking. People with COPD frequently also have cardiovascular disease, raising questions about whether heart medications such as beta blockers could improve overall outcomes. A new international trial suggests that adding the cardioselective beta blocker bisoprolol to standard COPD care offers no clear benefit.
Testing Beta Blockers in Patients with COPD
Beta blockers are widely used to reduce heart attacks and mortality in people with cardiovascular disease, but their role in COPD has been uncertain because of concerns about potential respiratory side effects. To address this, researchers conducted a large, double-blind, randomised phase 3 trial across 22 sites in Australia, India, New Zealand, and Sri Lanka.
The study enrolled adults aged 40–85 years with moderately severe COPD, defined by reduced lung function and a history of exacerbations. Participants were randomly assigned to receive either bisoprolol or a placebo for 2 years, alongside their usual COPD treatment.
No Improvement in Cardiorespiratory Outcomes
The primary outcome combined several clinically meaningful measures, including death, hospital admissions for heart or lung problems, COPD exacerbations, quality of life, and lung function. When these outcomes were analysed together, bisoprolol performed no better than placebo.
Rates of all-cause mortality, major cardiac events, hospitalisations and moderate-to-severe COPD exacerbations were similar in both groups. Measures familiar to clinicians, such as forced expiratory volume in one second (FEV1), symptom scores, and quality of life, also showed no significant differences.
Importantly, bisoprolol did not increase adverse events. COPD exacerbations were common in both groups, reflecting the underlying disease severity, but deaths were not attributed to the study drug.
What This Means for Everyday COPD Care
For clinicians, these findings suggest that routine use of bisoprolol solely to improve respiratory or combined cardiorespiratory outcomes in COPD is not supported by evidence. However, the results are equally reassuring in showing no signal of harm.
The study does not rule out beta blockers for patients with clear cardiac indications, such as heart failure or arrhythmias. Instead, it reinforces current guidance that beta blockers should be prescribed in COPD based on cardiovascular need, rather than as a strategy to modify COPD outcomes.
Overall, the trial highlights the importance of testing widely used cardiovascular drugs specifically in COPD populations, rather than assuming benefits seen in other groups will automatically apply.
Reference
Jenkins CR et al; PACE investigators. Bisoprolol to prevent adverse cardiac events (PACE) in COPD: a multicentre, double-blind, randomised, controlled, phase 3 trial. Lancet Respir Med. 2026;doi:10.1016/S2213-2600(25)00390-X.
