The Pharmaceutical Journal
Vol 269 No 7224 p704
16 November 2002

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Few adverse respiratory effects with beta-blockers

Cardioselective beta-blockers should not be withheld from patients with mild to moderate reactive airways disease, researchers say. This conclusion was drawn from a meta-analysis of data from 29 trials evaluating the effects of cardioselective beta-blockers on respiratory function in patients with reactive airway disease (asthma or chronic obstructive pulmonary disease with a reversible obstructive component).

The researchers found that cardioselective beta-blockers given for a few days to a few weeks did not produce clinically significant adverse respiratory effects in patients with mild to moderate reactive airways disease. The first dose of a cardioselective beta-blocker produced a small decrease in FEV₁ compared with that for placebo, which, the researchers say, was not associated with adverse respiratory effects. After continued treatment for a few days to a few weeks, FEV₁, symptoms and inhaler use did not differ between the treatment and placebo groups. Compared with placebo, single dose or continued treatment with a cardioselective beta-blocker was found to be associated with an increase in FEV₁ in response to beta2-agonists.

The researchers comment: "We believe these pooled results provide valuable information on the safety of cardioselective beta-blockers in patients with reactive airway disease, with or without concomitant COPD or cardiovascular disease." However, they are unable to comment on the effect of cardioselective beta-blockers on the frequency or severity of acute asthma exacerbations after several months of treatment (Annals of Internal Medicine 2002;137:715.)

In an accompanying editorial (ibid, p766), Dr Paul Epstein, deputy editor, says: "These drugs should be initiated at low doses and, if tolerated, the dose should then be increased as needed to achieve the desired clinical effect. Since no studies have yet been published that confirm the safety of cardiovascular beta-blockade in patients with exacerbations of asthma, continued caution remains appropriate in these patients."