Cardioselective β-Blockers in Patients with Reactive Airway Disease

Abstract

Objective: To assess the effect of cardioselective β-blockers on respiratory function of patients with reactive airway disease.

Data Sources: Comprehensive searches of the EMBASE, MEDLINE, and CINAHL databases from 1966 to May 2001 and scanning of references of the identified articles and related reviews.

Study Selection: Randomized, blinded, placebo-controlled trials that studied the effects of cardioselective β-blockers on FEV₁, symptoms, and the use of inhaled β₂-agonists in patients with reactive airway disease were selected. Interventions studied were the administration of a cardioselective β-blocker and administration of β₂-agonist after the study drug.

Data Extraction: Outcomes measured were the change in FEV₁ from baseline, the number of patients with respiratory symptoms, and the use of inhaled β₂-agonists with active treatment compared with placebo.

Data Synthesis: Nineteen studies on single-dose treatment and 10 studies on continued treatment were included. Administration of a single dose of a cardioselective β-blocker was associated with a 7.46% (95% CI, 5.59% to 9.32%) decrease in FEV₁ and a 4.63% (CI, 2.47% to 6.78%) increase in FEV₁ response to β-agonist compared with placebo, with no increase in symptoms. Trials lasting from 3 days to 4 weeks produced no significant change in FEV₁ (−0.42% [CI, −3.74% to 2.91%]), symptoms, or inhaler use compared with placebo but maintained an 8.74% (CI, 1.96% to 15.52%) increase in β-agonist response. No significant treatment effect in terms of FEV₁ was found in patients with concomitant chronic obstructive pulmonary disease, whether single doses (change in FEV₁, −5.28% [CI, −10.03% to −0.54%]) or continued treatment (change in FEV₁, 1.07% [CI, −3.3% to 5.44%]) was given.

Conclusions: Cardioselective β-blockers do not produce clinically significant adverse respiratory effects in patients with mild to moderate reactive airway disease. The results were similar for patients with concomitant chronic airways obstruction. Given their demonstrated benefit in such conditions as heart failure, cardiac arrhythmias, and hypertension, cardioselective β-blockers should not be withheld from patients with mild to moderate reactive airway disease.