Abstract
Beta-blockers are key in the management of cardiovascular diseases, but blocking airway beta2-receptors can cause severe and sometimes fatal bronchoconstriction in people with asthma. Although cardio-selective beta1-blockers may be safer than non-selective beta-blockers, they remain relatively contraindicated and under-prescribed. We review the evidence of the risk associated with cardio-selective beta1-blocker use in asthma.
Methods We searched “asthma” AND “beta-blocker” in PubMed and EmbaseOvid from start to May 2020. The World Health Organisation global database of individual case safety reports (VigiBase) was searched for reports of fatal asthma or bronchospasm and listed cardio-selective beta1-blockers use (accessed February 2020). Reports were examined for evidence of pre-existing asthma.
Results PubMed and EmbaseOvid searches identified 304 and 327 publications respectively. No published reports of severe or fatal asthma associated with cardio-selective beta1-blockers were found. Three large observational studies reported no increase in asthma exacerbations with cardio-selective beta1-blocker treatment. The VigiBase search identified five reports of fatalities in patients with pre-existing asthma and reporting asthma or bronchospasm during cardio-selective beta1-blocker use. Four of these deaths were unrelated to cardio-selective beta1-blocker use. The circumstances of the fifth death were unclear.
Conclusions There were no published reports of cardio-selective beta1-blockers causing asthma death. Observational data suggest that cardio-selective beta1-blocker use is not associated with increased asthma exacerbations. We found only one report of an asthma death potentially caused by cardio-selective beta1-blockers in a patient with asthma in a search of VigiBase. The reluctance to use cardio-selective beta1-blockers in people with asthma is not supported by this evidence.
Footnotes
This manuscript has recently been accepted for publication in the ERJ Open Research. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJOR online. Please open or download the PDF to view this article.
Conflict of interest: Dr. Bennett reports grants from Waikato Medical Research Foundation, during the conduct of the study;.
Conflict of interest: Dr. Chang has nothing to disclose.
Conflict of interest: Dr. Tatley has nothing to disclose.
Conflict of interest: Dr. Savage has nothing to disclose.
Conflict of interest: R.J. Hancox reports a proposed research grant on a related topic and travel to meetings supported by GSK, and travel to meetings supported by Boehringer Ingelheim and AstraZeneca, outside the submitted work.
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- Received October 30, 2020.
- Accepted December 23, 2020.
- ©The authors 2021
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