From the Guidelines
Beta blockers, sotalol, propafenone, and adenosine are not recommended in patients with obstructive lung disease who develop AF, as they can exacerbate Chronic Obstructive Pulmonary Disease (COPD) and asthma. According to the 2013 American College of Cardiology/American Heart Association task force on practice guidelines 1, these medications pose a significant risk to patients with bronchospastic lung disease. The guidelines specifically state that beta blockers, sotalol, propafenone, and adenosine are not recommended in patients with obstructive lung disease who develop atrial fibrillation, with a Level of Evidence: C.
Some key points to consider when managing patients with COPD or asthma who require antiarrhythmic therapy include:
- Avoiding the use of beta blockers, sotalol, propafenone, and adenosine due to their potential to worsen respiratory symptoms 1
- Considering alternative antiarrhythmic classes, such as calcium channel blockers or class III agents, although sotalol's beta-blocking properties should be taken into account
- Carefully monitoring patients for increased wheezing, shortness of breath, or decreased peak flow measurements when using any beta-blocker
It is essential to prioritize the patient's respiratory health and carefully weigh the benefits and risks of antiarrhythmic therapy in patients with COPD or asthma, as recommended by the guidelines 1.
From the FDA Drug Label
Beta-adrenergic receptor blockade can cause reduction of intraocular pressure While taking beta-blockers, patients with a history of severe anaphylactic reaction to a variety of allergens may be more reactive to repeated challenge, either accidental, diagnostic, or therapeutic Such patients may be unresponsive to the usual doses of epinephrine used to treat allergic reaction
The antiarrhythmic medications that can exacerbate Chronic Obstructive Pulmonary Disease (COPD) and asthma are beta-blockers, such as:
- Propranolol 2
- Bisoprolol 3 These medications can cause beta-adrenergic receptor blockade, which may lead to a reduction in intraocular pressure and increased reactivity to allergens, potentially worsening COPD and asthma symptoms.
From the Research
Antiarrhythmic Medications and COPD/Asthma
- Non-selective beta-blockers may induce bronchospasm and are not recommended for COPD patients 4
- The use of non-selective beta-blockers can exacerbate asthma, and their risk outweighs any potential benefits for clinical indications 5
- Cardio-selective beta-blockers, such as bisoprolol, metoprolol, or nebivolol, can be used in managing patients with COPD and cardiovascular diseases, but should be started at a low dose and with careful monitoring 4, 6
- Beta-blockers with intrinsic sympathomimetic activity may have a lower probability of bronchial obstruction in COPD patients, but their comparison with cardioselective beta-blockers is limited 4
- The use of selective beta-blockers in patients with moderate COPD may represent a better choice of pharmacological approach, with a trend towards a decrease in exacerbations compared to other treatments 7
- Metoprolol was associated with a higher risk of exacerbation leading to hospitalization in patients with moderate or severe COPD 6
Key Considerations
- Patients with COPD and asthma should be carefully evaluated before prescribing beta-blockers, considering the potential risks and benefits 4, 5
- The treatment with beta-blockers should be started outside exacerbation of COPD and from a small dose, with careful monitoring for possible new symptoms 4
- Cardio-selective beta-blockers may be used in patients with asthma and comorbidities, but preferably in low doses and when strongly indicated 5