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
Text Size: A A A
Published online

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.

Figures in this Article

Sign In to Access Full Content

Want to Purchase a Subscription?

New to CHEST? Become an ACCP member to receive a full subscription to both the print and online editions.
Want to access your Institution's subscription?
Sign in to your individual user account while you are actively authenticated on this website via your institution (Learn more about institutional authentication). We will then sustain your personal access to their content/subscription for 90 days, after which you can repeat this process.

Sign In to Access Full Content

Want to Purchase a Subscription?

New to CHEST? Become an ACCP member to receive a full subscription to both the print and online editions.




Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
PubMed Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543