Chronic obstructive pulmonary disease (COPD) and coronary heart disease share smoking as the most important common risk factor and there is a high prevalence of cardiovascular disease among COPD patients. Although cardioselective beta-blockers are safe in treatment of COPD, they are often withheld in these patients. In observational studies, beta-blocker treatment is associated with significantly reduced mortality and reduced risk of exacerbations of COPD. This effect may be caused by the beneficial effect of beta-blockers on heart failure, tachycardia and upregulation of beta-receptors in the airways.