Randomized placebo-controlled trial to evaluate chronic dosing effects of propranolol in asthma - PubMed (original) (raw)

Randomized Controlled Trial

. 2013 Jun 15;187(12):1308-14.

doi: 10.1164/rccm.201212-2206OC.

Affiliations

• PMID: 23593932
• DOI: 10.1164/rccm.201212-2206OC

Randomized Controlled Trial

Randomized placebo-controlled trial to evaluate chronic dosing effects of propranolol in asthma

Philip M Short et al. Am J Respir Crit Care Med. 2013.

Abstract

Rationale: Unblinded studies have shown improvements in airway hyperresponsiveness with chronic nadolol in steroid-naive patients with asthma.

Objectives: To assess the effects of chronic nonselective β-blockade as add-on to inhaled corticosteroids (ICS) in patients with asthma.

Methods: A double-blind randomized placebo-controlled crossover trial of propranolol in patients with mild-to-moderate asthma receiving ICS was performed. Participants underwent a 6- to 8-week dose titration of propranolol or placebo as tolerated to a maximum of 80 mg per day. Tiotropium was given for the first 4 to 6 weeks of each treatment period.

Measurements and main results: Primary outcome was methacholine challenge. Secondary outcomes included histamine challenge, pulmonary function, mini-asthma quality of life questionnaire (mini-AQLQ), and asthma control questionnaire (ACQ). Eighteen patients completed (mean [SEM]): age, 36 (4) yr; FEV1%, 93 (2); ICS, 440 (66) μg/d. No significant difference was observed in methacholine or histamine challenge after exposure to propranolol versus placebo. For methacholine challenge, the doubling dilution difference was 0.04 (95% confidence interval [CI], -0.56 to 0.63), P = 0.89. Albuterol recovery at 20 minutes after histamine challenge was partially attenuated by propranolol versus placebo: FEV1% mean difference, 5.28 (95% CI, 2.54-8.01), P = 0.001. After chronic β-blockade there was a small worsening in FEV1 % predicted of 2.4% (95% CI, -0.1 to 4.8), P = 0.055. No difference was found for ACQ or mini-AQLQ.

Conclusions: This is the first placebo-controlled study to assess the effects of chronic nonselective β-blockade in asthma, showing no significant effect of propranolol compared with placebo on either methacholine or histamine airway hyperresponsiveness and no change in ACQ or AQLQ. Clinical trial registered with www.clinicaltrials.gov (NCT01074853).

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Comment in

• What doesn't kill may not make you stronger. β-blockers for asthma.
  Kazani S, Israel E. Kazani S, et al. Am J Respir Crit Care Med. 2013 Jun 15;187(12):1281. doi: 10.1164/rccm.201305-0815ED. Am J Respir Crit Care Med. 2013. PMID: 23767898 No abstract available.
• The intrinsic bias of generalizations.
  Bond RA. Bond RA. Am J Respir Crit Care Med. 2014 Feb 1;189(3):359. doi: 10.1164/rccm.201306-1109LE. Am J Respir Crit Care Med. 2014. PMID: 24484333 Free PMC article. No abstract available.
• Far from "disappointing".
  Penn RB. Penn RB. Am J Respir Crit Care Med. 2014 Feb 1;189(3):360. doi: 10.1164/rccm.201306-1143LE. Am J Respir Crit Care Med. 2014. PMID: 24484334 Free PMC article. No abstract available.
• Reply: Pharmacological obfuscation of clinical relevance.
  Lipworth B, Short P, Anderson W, Williamson P. Lipworth B, et al. Am J Respir Crit Care Med. 2014 Feb 1;189(3):360-1. doi: 10.1164/rccm.201306-1166LE. Am J Respir Crit Care Med. 2014. PMID: 24484335 No abstract available.
• Reply: "The intrinsic bias of generalizations" and "Far from 'disappointing'".
  Kazani S, Israel E. Kazani S, et al. Am J Respir Crit Care Med. 2014 Feb 1;189(3):361-2. doi: 10.1164/rccm.201308-1410LE. Am J Respir Crit Care Med. 2014. PMID: 24484336 No abstract available.

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