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In a large observational study (doi:10.1136/bmj.f6650), Quint and colleagues show that β blockers started before or during hospital admission after myocardial infarction are associated with substantial survival benefits for adults with chronic obstructive pulmonary disease (COPD). They found an adjusted hazard ratio of 0.59 (95% confidence interval 0.44 to 0.79) in those who were already taking β blockers and 0.50 (0.36 to 0.69) in those who started taking them in hospital.1

Randomised controlled trials have already shown that β blockers reduce mortality after myocardial infarction in the general population,2 and a decade ago two large observational studies suggested that this was also true for people with COPD.3 4Other observational studies have even suggested that β blockers may be beneficial for a wider population of patients with COPD.4 5 A recent meta-analysis of nine cohort studies that comprised nearly 100 000 patients with COPD showed a consistent pattern, with a pooled relative risk of mortality of 0.69 (0.62 to 0.78) with β blockade.6 In one study, β blockade was associated with a reduction …