From the Guidelines
Bisoprolol, metoprolol succinate, or nebivolol are safe to use in patients with asthma.
Rationale
- These beta blockers are more selective β1-adrenoceptor antagonists, which means they are less likely to cause bronchospasm in patients with asthma 1.
- The contraindication to beta-blockers in asthma is based on outdated case series with high initial dosages in young patients with severe asthma, and not applicable to modern clinical practice 1.
- Low doses of cardioselective beta-blockers can be used in patients with asthma, under close medical supervision, with consideration of the risks for and against their use 1.
- Beta-1 selective beta blockers may even reduce COPD exacerbations and do not affect the action of bronchodilators, but reduce the heart rate acceleration caused by their use 1.
- In patients with chronic obstructive lung disease or a history of asthma, beta blockers are not contraindicated in the absence of active bronchospasm, and beta-1 selective beta blockers are preferred 1.
From the Research
Beta Blockers in Asthma
- The use of beta blockers in patients with asthma has been a topic of concern due to the potential for worsening bronchospasm 2, 3, 4, 5, 6
- However, some studies suggest that certain beta blockers, such as cardioselective beta blockers, may be safe to use in patients with asthma 3, 4, 5, 6
Cardioselective Beta Blockers
- Cardioselective beta blockers, such as bisoprolol, have been shown to be well tolerated in patients with mild asthma and may not significantly impair the response to salbutamol 3, 4, 5, 6
- A study found that the bronchodilator response to rescue salbutamol after mannitol-induced bronchoconstriction is non-inferior during regular treatment with bisoprolol compared to placebo 6
- Another study found that cardioselective beta blockers may be used in patients with asthma when strongly indicated and other therapeutic options are not available 4
Non-Selective Beta Blockers
- Non-selective beta blockers, such as nadolol, may not be suitable for patients with asthma due to the potential for worsening bronchospasm 2
- However, a study found that nadolol was well tolerated in patients with mild asthma and may have beneficial effects on airway hyperresponsiveness 2
Specific Beta Blockers
- Bisoprolol has been shown to be safe and well tolerated in patients with mild asthma 6
- Atenolol and metoprolol have also been evaluated in patients with asthma and hypertension, and were generally well tolerated except at higher doses 5
- Nadolol has been shown to be well tolerated in patients with mild asthma, but its use in patients with asthma is still a topic of debate 2