Beta-blockers in asthma: myth and reality

ABSTRACT

Introduction: Patients with asthma often have important co-morbidities which reduce the likelihood of gaining optimal asthma control. Beta2-blockers are commonly prescribed for the treatment of different clinical indications, including coronary artery disease, cardiac arrhythmia, arterial hypertension, heart failure and glaucoma.

Areas covered: The aim of this reviw is to summarize current evidence on the effect of systemic and local β-blockers on asthma outcomes based on their pharmacologic properties,and to help clinicians when prescribing for patients with asthma and co-morbidities. Current data suggest that risk of asthma worsening from systemic and local use of non-selective β-blockers outweighs any potential benefits for their clinical indications. Recent studies confirm that topical and systemic prescription of cardio-selective β-blockers is not associated with a significant increased risk of moderate or severe asthma exacerbations.

Expert opinion: Non-selective β-blockers should not be prescribed for the management of comorbidities in patients with asthma while cardio-selective β-blockers, preferably in low doses, may be used when strongly indicated and other therapeutic options are not available. More prospective real-life studies are needed to evaluate the risk of long-term use of β-blockers in patients with asthma.

KEYWORDS:

• Asthma outcomes
• β-blockers
• cardiovascular comorbidity
• glaucoma
• treatment

Article highlights

• Beta-blockers are largely prescribed in cardio-vascular diseases and glaucoma which represent frequent comorbidities in patients with asthma.

• Historically, β-blockers are contraindicated in people with asthma because they increase airway hyperresponsiveness and may trigger exacerbations.

• Despite important pharmacological differences, β-blockers are often regarded as a single class of drugs.

• Cardio-selective β-blockers are now accepted by several guidelines (but not by all) in patients with asthma who need this treatment but are underused in practice.

• The prescription of β-blockers in patients with asthma should also consider other pharmacologic properties of these drugs (i.e. presence of intrinsic sympathomimetic activity signaling profile of the ligand).

• Low dose initiation with gradual increase is recommended to avoid the adverse effects.

Acknowledgments

The authors would like to thank the Interasma European Scientific network (INES).

Declaration of interest

K Kowal reports personal fees from Astra Zeneca, personal fees from Berlin Chemie, Chiesi, Hal Allergy, Orion Pharma, outside the submitted work. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.