Asthma: cardioselective beta-blockers lead to small falls in FEV1, but do not worsen symptoms in mild-moderate cases

Clinical bottom line (level 1a)

  1. Patients with mild-moderate reversible airways disease who take a cardioselective beta-blocker have a small initial fall in FEV 1 (on average 8%), without any clear increase in adverse respiratory symptoms.
  2. Patients on cardioselective beta-blockers long-term do not clearly have a fall in FEV 1 .
Salpeter et al: Cochrane Library 2001; 2 : -
Expires May 2004

The study

Systematic review of all randomised placebo-controlled trials of
  • Patients: reversible airways disease
  • Intervention: single dose or longer duration of cardioselective beta-blockers (atenolol, metoprolol, bisoprolol, practolol, celiprolol, acebutolol, and xamoterol)
  • Outcome: FEV 1
Articles found in all languages using Medline, Embase, CINAHL, 1966 to February 2000 (search terms: asthma*, bronchial hyperreactivity*, respiratory sounds*, wheez*, obstructive lung disease* or obstructive airways disease* adn adrenergic antagonist*, sympatholytic* or adrenergic receptor block* )

Selection criteria: by 2 independent reviewers, who resolved differences by consensus
Appraisal criteria: by 2 independent reviewers using randomisation and blinding
Articles excluded if:
  • single-dose studies that failed to withhold beta-2 agonists for at least 8 hours before dosing
  • non-selective betablockers used
  • duplicate publications
  • patients enrolled based on a previous response to beta-blockers
  • inappropriate definition of reversible airways disease
29 RCTs found - 19 on single-dose treatment involving 240 patients with mild-moderate reversible airways disease. 10 on longer-term treatment ranging from 3 days to 4 weeks involving 141 patients.
Studies were found to be heterogeneous for the effect size, but not overall direction.

The evidence

  • Single-dose studies: fall in FEV1: 8.0% (95% CI: 6.2% to 9.8%)
  • Longer-term studies: fall in FEV1: 0.4% (95% CI: -2.9% to 3.7%)
  • No study reported an increase in adverse respiratory symptoms.

Citation

  1. Salpeter S, Ormiston T, Salpeter E: cardioselective beta-blocker use in patients with reversible airway disease. Cochrane Library 2001; 2 : -
Search Terms: from ACP Journal Club
Contributor: Chris Ball, May 2002
Reviewer:

Clinical Question.
Patient mild-moderate reversible airways disease, asthma
Intervention or Exposure cardioselective beta-blocker
Outcome fall in FEV1, respiratory symptoms