For clinicians who treat patients with respiratory diseases, the use of β-blockers has, for a long time, posed a dilemma because of the potential risk of bronchospasm and neutralisation of the effectiveness of β-2 agonists. This predicament is particularly challenging for patients with chronic obstructive pulmonary disease (COPD), many of whom have substantial cardiovascular comorbidity,1 and in whom the avoidance of β-blockers might deprive them of substantial cardiovascular benefit.

In the last few years, this restraint has been challenged, and rightfully so, in view of the general scarcity of data on this potential antagonism and, more importantly, its would-be effect on major outcomes. While caution is generally the sensible approach in drug safety, this is less the case here, as one would be withholding a treatment that has been demonstrated to be effective for cardiovascular disease. Several observational studies have examined the potential risks and benefits...