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Original Research: Asthma |

Adverse Respiratory Effect of Acute β-Blocker Exposure in AsthmaAcute 03B2-Blockade in Asthma: A Meta-analysis: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Daniel R. Morales, MBChB; Cathy Jackson, MD; Brian J. Lipworth, MD; Peter T. Donnan, PhD; Bruce Guthrie, PhD
Author and Funding Information

From the Quality, Safety, and Informatics Group (Drs Morales and Guthrie), Asthma and Allergy Research Group (Dr Lipworth), and Dundee Epidemiology and Biostatistics Unit (Dr Donnan), Medical Research Institute, University of Dundee, Dundee; and the Bute Medical School (Dr Jackson), University of St Andrews, Fife, Scotland.

Correspondence to: Daniel R. Morales, MBChB, Quality, Safety, and Informatics Group, Medical Research Institute, University of Dundee, Mackenzie Bldg, Dundee, DD2 4BF, Scotland; e-mail: danielmorales@nhs.net


Funding/Support: This study was funded by a Scottish Government Chief Scientist Office Clinical Academic Fellowship, which provided research costs and support for Dr Morales [Grant CAF/11/07].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


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

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