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Chest. 2014 Apr;145(4):779-786. doi: 10.1378/chest.13-1235.

Adverse respiratory effect of acute β-blocker exposure in asthma: a systematic review and meta-analysis of randomized controlled trials.

Author information

1
Quality, Safety, and Informatics Group, Medical Research Institute, University of Dundee, Dundee. Electronic address: danielmorales@nhs.net.
2
Bute Medical School, University of St Andrews, Fife, Scotland.
3
Asthma and Allergy Research Group, Medical Research Institute, University of Dundee, Dundee.
4
Dundee Epidemiology and Biostatistics Unit, Medical Research Institute, University of Dundee, Dundee.
5
Quality, Safety, and Informatics Group, Medical Research Institute, University of Dundee, Dundee.

Abstract

BACKGROUND:

β-Blockers are avoided in asthma over concerns regarding acute bronchoconstriction. Risk is greatest following acute exposure, including the potential for antagonism of β2-agonist rescue therapy.

METHODS:

A systematic review of databases was performed to identify all randomized, blinded, placebo-controlled clinical trials evaluating acute β-blocker exposure in asthma. Effect estimates for changes in respiratory function, symptoms, and β2-agonist response were pooled using random effects meta-analysis with heterogeneity investigated.

RESULTS:

Acute selective β-blockers in the doses given caused a mean change in FEV1 of −6.9% (95% CI, −8.5 to −5.2), a fall in FEV1 of ≥20% in one in eight patients (P=.03), symptoms affecting one in 33 patients (P=.18), and attenuation of concomitant β2-agonist response of −10.2% (95% CI, −14.0 to −6.4). Corresponding values for acute nonselective β-blockers in the doses given were −10.2% (95% CI, −14.7 to −5.6), one in nine patients (P=.02), one in 13 patients (P=.14), and −20.0% (95% CI, −29.4 to −10.7). Following investigation of heterogeneity, clear differences were found for celiprolol and labetalol. A dose-response relationship was demonstrated for selective β-blockers.

CONCLUSIONS:

Selective β-blockers are better tolerated but not completely risk-free. Risk from acute exposure may be mitigated using the smallest dose possible and β-blockers with greater β1-selectivity. β-Blocker-induced bronchospasm responded partially to β2-agonists in the doses given with response blunted more by nonselective β-blockers than selective β-blockers. Use of β-blockers in asthma could possibly be based upon a risk assessment on an individual patient basis.

PMID:
24202435
DOI:
10.1378/chest.13-1235
[Indexed for MEDLINE]

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