The safety of cardioselective β1-blockers in asthma: literature review and search of global pharmacovigilance safety reports - PubMed (original) (raw)

Review

The safety of cardioselective β1-blockers in asthma: literature review and search of global pharmacovigilance safety reports

Miriam Bennett et al. ERJ Open Res. 2021.

Abstract

Introduction: Beta-blockers are key in the management of cardiovascular diseases but blocking airway β2-receptors can cause severe and sometimes fatal bronchoconstriction in people with asthma. Although cardioselective β1-blockers may be safer than non-selective β-blockers, they remain relatively contraindicated and under-prescribed. We review the evidence of the risk associated with cardioselective β1-blocker use in asthma.

Methods: We searched "asthma" AND "beta-blocker" in PubMed and EmbaseOvid from start to May 2020. The World Health Organization (WHO) global database of individual case safety reports (VigiBase) was searched for reports of fatal asthma or bronchospasm and listed cardioselective β1-blocker use (accessed February 2020). Reports were examined for evidence of pre-existing asthma.

Results: PubMed and EmbaseOvid searches identified 304 and 327 publications, respectively. No published reports of severe or fatal asthma associated with cardioselective β1-blockers were found. Three large observational studies reported no increase in asthma exacerbations with cardioselective β1-blocker treatment. The VigiBase search identified five reports of fatalities in patients with pre-existing asthma and reporting asthma or bronchospasm during cardioselective β1-blocker use. Four of these deaths were unrelated to cardioselective β1-blocker use. The circumstances of the fifth death were unclear.

Conclusions: There were no published reports of cardioselective β1-blockers causing asthma death. Observational data suggest that cardioselective β1-blocker use is not associated with increased asthma exacerbations. We found only one report of an asthma death potentially caused by cardioselective β1-blockers in a patient with asthma in a search of VigiBase. The reluctance to use cardioselective β1-blockers in people with asthma is not supported by this evidence.

©The authors 2021.

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Conflict of interest statement

Conflict of interest: M. Bennett reports grants from Waikato Medical Research Foundation during the conduct of the study. Conflict of interest: C.L. Chang has nothing to disclose. Conflict of interest: M. Tatley has nothing to disclose. Conflict of interest: R. Savage has nothing to disclose. Conflict of interest: R.J. Hancox reports a proposed research grant on a related topic and travel to meetings supported by GSK, and travel to meetings supported by Boehringer Ingelheim and AstraZeneca, outside the submitted work.

Figures

FIGURE 1

FIGURE 1

Pictorial representation of β-adrenoceptor activity in the presence of background catecholamines, β-agonists and β-blockers. ISA: intrinsic sympathomimetic activity.

FIGURE 2

FIGURE 2

PRISMA flow diagram of articles considered in the literature review.

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