 Chronic obstructive pulmonary disease COPD is a major cause of illness and death. In fact, by 2020, the World Health Organization predicts that COPD will become the third leading cause of death currently fourth, and the fifth leading cause of disability currently twelfth worldwide. COPD and cardiovascular heart disease are intertwined due to the associated risk of smoking related atherosclerosis. Beta-blockers are generally avoided in COPD patients due to the associated risk of worsening lung function and acute bronchospasm airway narrowing due to beta-2-receptor blockade. Despite these concerns a recent Cochrane review has shown that chronic beta-blockade with cardioselective beta-blockers for example bisoprolol that preferentially block beta-1 mostly heart over beta-2 mostly airway receptors are well tolerated with less beta-2-blockade and subsequently less bronchospasm. 