Are Beta-1–Blockers Safe for Patients with Lung Disease?

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The summary below is from the full report titled "Cardioselective ß-Blockers in Patients with Reactive Airway Disease: A Meta-Analysis." It is in the 5 November 2002 issue of Annals of Internal Medicine (volume 137, pages 715-725). The authors are SR Salpeter, TM Ormiston, and EE Salpeter.

What is the problem and what is known about it so far?

Doctors use ß-blocker drugs to treat many conditions, including high blood pressure, chest pain (angina), heart attacks, and migraine headaches. There are several types of ß-blockers. Cardioselective ß-blockers (ß-1–blockers) act mainly on the heart. They slow heart rate, decrease blood pressure, and reduce the heart's workload. Other ß-blockers act on the heart but also may narrow blood vessels throughout the body and the airways to the lungs (bronchi).

Doctors often avoid ß-blockers in patients with lung diseases such as asthma. They worry that the drugs will narrow airways and cause severe asthma attacks or sudden shortness of breath. Unfortunately, many patients have both lung disease and a condition that can be treated with ß-blockers. In theory, the ß-1–blockers that act mainly on the heart may be "safe" for these patients. But what does research evidence show?

Why did the researchers do this particular study?

The researchers wanted to see whether ß-1–blockers worsen lung function and symptoms in patients with airway disease.

Who was studied?

381 adults with reactive airway disease (asthma) who had participated in 1 of 29 different studies.

How was the study done?

Rather than doing a new study, the researchers summarized information from previous randomized trials. They looked at trials that compared ß-1–blockers with dummy (placebo) drugs in patients with mild to moderate reactive airway disease. They checked the following outcomes from these trials: symptoms of lung disease, use of inhaled asthma drugs, and the maximum amount of air that patients could exhale in 1 second (a measure called FEV₁) before and after taking a ß-1–blocker.

What did the researchers find?

19 trials assessed outcomes after one dose of a ß-1–blocker. Compared with placebo, the ß-1–blockers decreased FEV₁ only a small amount and did not increase symptoms. In 10 trials, ß-1–blockers were given for 3 days to 4 weeks. Compared with placebo, the ß-1–blockers did not increase symptoms or inhaler use and did not worsen FEV₁.

What were the limitations of the study?

In the reviewed trials, patients took ß-1–blockers only for short periods (1 day to 4 weeks). None of the trials included patients with severe airway disease.

What are the implications of the study?

Beta-1–blockers do not significantly worsen lung function or symptoms in patients with mild to moderate reactive airway disease. They should not be withheld from patients with reactive airway disease who would otherwise benefit from them.