From the Guidelines
Propranolol should not be taken with asthma due to its potential to cause bronchoconstriction and trigger severe asthma attacks, although cardioselective beta-blockers may be used with caution and close monitoring in certain cases. When considering the use of beta-blockers in patients with asthma, it is essential to weigh the potential benefits against the risks, as beta-blockers can exacerbate asthma symptoms by blocking beta-2 receptors in the lungs, which help keep airways open 1. The 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure suggest that beta-blockers are only relatively contraindicated in asthma, but not in COPD, and that a more selective β1-adrenoceptor antagonist, such as bisoprolol, metoprolol succinate, or nebivolol, is preferred 1. Some key points to consider when deciding whether to use propranolol in a patient with asthma include:
- The potential for propranolol to cause bronchoconstriction and trigger severe asthma attacks
- The availability of alternative medications that do not affect the respiratory system
- The importance of close monitoring and caution when using cardioselective beta-blockers in patients with asthma
- The need to inform healthcare providers about asthma history before starting any new medication, especially beta-blockers like propranolol. In clinical practice, starting with low doses of cardioselective beta-blockers combined with close monitoring for signs of airway obstruction may allow the use of profoundly effective beta-blockers in certain cases, especially in older people where true severe asthma is uncommon 1.
From the FDA Drug Label
CONTRAINDICATIONS Propranolol is contraindicated in 1) cardiogenic shock; 2) sinus bradycardia and greater than first-degree block; 3) bronchial asthma; and 4) in patients with known hypersensitivity to propranolol hydrochloride. Nonallergic Bronchospasm (e.g., Chronic Bronchitis, Emphysema): In general, patients with bronchospastic lung disease should not receive beta-blockers. Propranolol should be administered with caution in this setting since it may provoke a bronchial asthmatic attack by blocking bronchodilation produced by endogenous and exogenous catecholamine stimulation of beta-receptors
Propranolol is contraindicated in patients with bronchial asthma. Patients with chronic obstructive airway disease should not receive beta-blockers, including propranolol, as it may provoke a bronchial asthmatic attack. Therefore, propranolol should not be taken with asthma (chronic obstructive airway disease) 2 2.
From the Research
Propranolol and Asthma
- Propranolol is a non-selective beta-blocker, which means it can block both beta-1 and beta-2 adrenergic receptors 3.
- Blocking beta-2 receptors can cause bronchoconstriction, which can worsen asthma symptoms 4, 5.
- Studies have shown that propranolol can cause severe bronchoconstriction in patients with asthma, and its use is generally not recommended in these patients 3, 6.
Risks of Propranolol in Asthma
- A study published in 2021 found that infusion of propranolol was associated with a significantly higher incidence of asthma attack than placebo, with a risk ratio of 10.19 (95% CI 1.29-80.41) 6.
- Another study published in 1982 found that propranolol caused pronounced bronchoconstriction in six out of 14 asthmatic patients 3.
- The use of propranolol in patients with asthma is generally considered to be contraindicated, and alternative treatments should be considered 4, 5.
Alternative Beta-Blockers
- Cardioselective beta-blockers, such as bisoprolol and atenolol, may be safer for use in patients with asthma, as they are less likely to cause bronchoconstriction 5, 7.
- However, the use of any beta-blocker in patients with asthma should be carefully considered, and the potential benefits and risks should be weighed 4, 5.