From the Guidelines
Beta blockers should not be restarted during an active asthma exacerbation, as they can worsen bronchospasm by blocking beta-2 receptors in the lungs. When managing asthma exacerbations, the primary focus is on administering oxygen, inhaled beta-2 agonists, and systemic corticosteroids, with the dose and frequency of administration dependent on the severity of the exacerbation 1. The use of beta blockers, particularly non-selective ones like propranolol, is not recommended during an active exacerbation due to their potential to exacerbate bronchospasm. If a patient with asthma requires beta blocker therapy for conditions like hypertension or heart disease, it is best to wait until the exacerbation has fully resolved and lung function has returned to baseline before reinitiating treatment 1. When restarting beta blockers is appropriate, cardioselective beta blockers such as metoprolol or bisoprolol are preferred as they primarily target beta-1 receptors in the heart with less effect on the lungs. Even with these medications, starting at a low dose and gradually titrating upward under close medical supervision is recommended. For patients with severe or poorly controlled asthma, alternative medications that don't affect the respiratory system should be considered instead of beta blockers whenever possible 1. Key considerations in managing asthma exacerbations include:
- Immediate evaluation and treatment
- Administration of oxygen, inhaled beta-2 agonists, and systemic corticosteroids
- Monitoring of lung function and adjustment of treatment based on severity
- Consideration of alternative medications for patients with severe or poorly controlled asthma.
From the FDA Drug Label
Patients with bronchospastic disease, should, in general, not receive beta-blockers, including metoprolol. Because of its relative beta 1 selectivity, however, metoprolol may be used in patients with bronchospastic disease who do not respond to, or cannot tolerate, other antihypertensive treatment Bronchodilators, including beta 2 agonists, should be readily available or administered concomitantly.
Restarting beta blockers in asthma exacerbation is not recommended. The drug label advises against using beta blockers, including metoprolol, in patients with bronchospastic disease. Although metoprolol may be used in certain cases due to its relative beta 1 selectivity, caution is advised and bronchodilators should be readily available. In the event of an asthma exacerbation, it is not recommended to restart beta blockers without careful consideration and monitoring 2.
From the Research
Asthma Exacerbation and Beta Blockers
- The use of beta blockers in patients with asthma can be a concern due to the potential for exacerbating asthma symptoms 3, 4.
- Non-selective beta blockers are more likely to cause asthma exacerbations, while cardio-selective beta blockers may be safer for patients with asthma 3, 5.
- A study found that oral timolol and infusion of propranolol were associated with a significantly higher risk of developing an asthma attack in patients, especially in those with a baseline asthma history 4.
Management of Asthma Exacerbations
- Asthma exacerbations can be managed with inhaled corticosteroids, short-acting beta2 agonists, and oral corticosteroids 6, 7.
- The addition of a short-acting muscarinic antagonist and magnesium sulfate infusion has been associated with fewer hospitalizations 6.
- Patients with severe exacerbations should be transferred to an acute care facility and treated with oxygen, frequent administration of a short-acting beta2 agonist, and corticosteroids 6, 7.
Beta Blockers and Asthma Treatment
- Cardio-selective beta blockers, such as bisoprolol, may not impair the bronchodilator response to salbutamol in patients with asthma 5.
- A study found that the bronchodilator response to rescue salbutamol after mannitol-induced bronchoconstriction was non-inferior during regular treatment with bisoprolol compared to placebo 5.
- However, non-selective beta blockers should not be prescribed for the management of comorbidities in patients with asthma, while cardio-selective beta blockers may be used when strongly indicated and other therapeutic options are not available 3.