Acute β-blockade: risk of adverse respiratory effects in asthma

Reactions 1502, p3 - 24 May 2014 Acute β-blockade: risk of adverse respiratory effects in asthma Acute β-blocker exposure can have adverse respiratory effects in patients with asthma, according to a study published in Chest. The study used data from 32 randomised, blinded, placebo-controlled clinical trials, published on or before 20 January 2013, to evaluate changes in respiratory function and β 2 -agonist efficacy following acute β- blocker exposure in patients with asthma. The meta-analysis showed that, compared with placebo, acute selective β-blockers caused significant mean reductions in FEV 1 (–6.9%; 95% CI –8.5, –5.2). The risk difference for fall in FEV 1 of ≥ 20% was significant, affecting 13% of patients. Selective β-blockers also caused non-significant increases in symptoms. Non- selective β-blockers caused significant reductions in FEV1 that were larger than those caused by selective β- blockers (mean –10.2%; –14.7, –5.6) and significant increases in symptoms, affecting 8% of patients. However, the risk difference for fall in FEV 1 of ≥ 20% was not significant. "Although reasonably well tolerated by the majority, acute selective β-blockade may cause detrimental changes in lung function in susceptible patients with asthma. However, risk from acute exposure in patients with controlled asthma may be mitigated by commencing the lowest dose possible and using a highly selective agent, with reassurance that any bronchoconstriction responds reasonably well to β 2 -agonists," conclude the researchers. Morales DR, et al. Adverse Respiratory Effect of Acute [beta]-Blocker Exposure in Asthma - A Systematic Review and Meta-analysis of Randomized Controlled Trials. Chest 145: 779-786, No. 4, 7 May 2014. Available from: URL: http:// journal.publications.chestnet.org/data/Journals/CHEST/929928/ chest_145_4_779.pdf 803103245 1 Reactions 24 May 2014 No. 1502 0114-9954/14/1502-0001/$14.95 Adis © 2014 Springer International Publishing AG. All rights reserved

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Transcript of Acute β-blockade: risk of adverse respiratory effects in asthma

Reactions 1502, p3 - 24 May 2014

Acute β-blockade: risk of adverserespiratory effects in asthma

Acute β-blocker exposure can have adverserespiratory effects in patients with asthma, according toa study published in Chest.

The study used data from 32 randomised, blinded,placebo-controlled clinical trials, published on or before20 January 2013, to evaluate changes in respiratoryfunction and β2-agonist efficacy following acute β-blocker exposure in patients with asthma.

The meta-analysis showed that, compared withplacebo, acute selective β-blockers caused significantmean reductions in FEV1 (–6.9%; 95% CI –8.5, –5.2). Therisk difference for fall in FEV1 of ≥ 20% was significant,affecting 13% of patients. Selective β-blockers alsocaused non-significant increases in symptoms. Non-selective β-blockers caused significant reductions inFEV1 that were larger than those caused by selective β-blockers (mean –10.2%; –14.7, –5.6) and significantincreases in symptoms, affecting 8% of patients.However, the risk difference for fall in FEV1 of ≥ 20% wasnot significant. "Although reasonably well tolerated bythe majority, acute selective β-blockade may causedetrimental changes in lung function in susceptiblepatients with asthma. However, risk from acuteexposure in patients with controlled asthma may bemitigated by commencing the lowest dose possible andusing a highly selective agent, with reassurance that anybronchoconstriction responds reasonably well toβ2-agonists," conclude the researchers.Morales DR, et al. Adverse Respiratory Effect of Acute [beta]-Blocker Exposure inAsthma - A Systematic Review and Meta-analysis of Randomized ControlledTrials. Chest 145: 779-786, No. 4, 7 May 2014. Available from: URL: http://journal.publications.chestnet.org/data/Journals/CHEST/929928/chest_145_4_779.pdf 803103245