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94; 95% CI 0.81 to 1.05). There was a significant interaction by treatment assignment, and in stratified analysis the protective effects of a higher CI-6MW on AECOPD were negated by metoprolol use. Higher CI-6MW is associated with decreased risk of AECOPD and may be an indicator of susceptibility to adverse effects of metoprolol. Higher CI-6MW is associated with decreased risk of AECOPD and may be an indicator of susceptibility to adverse effects of metoprolol.Urea is authorised in the European Union (EU) as feed additive for ruminants.