David J. Shulan, MD; Michael Katlan, MD; Mollie Lavsky-Shulan, MD
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Shulan DJ, Katlan M, Lavsky-Shulan M. Use of β-Blockers in Patients with Reactive Airway Disease. Ann Intern Med. 2003;139:304. doi: 10.7326/0003-4819-139-4-200308190-00020
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Published: Ann Intern Med. 2003;139(4):304.
TO THE EDITOR:
We are very concerned about the conclusions of Salpeter and colleagues' meta-analysis on cardioselective β-blockers in patients with reactive airway disease (1). With reactive airway disease, the immediate drop in FEV1 may not indicate the risk to patients taking β-blocking medications. In the 10 continued treatment studies, only 141 participants received β-blockers for 3 days to 4 weeks. Individuals with mild to moderate asthma may tolerate β-blockade well between asthma triggers. Long-term studies (≥ 1 year) must be performed to examine the frequency of asthma exacerbations and steroid burst, as well as hospitalization and death rates, before the true safety of β-blockade can be ascertained. Most persons with reactive airway disease can tolerate a substantial degree of airway obstruction until challenged with exercise, a viral respiratory infection, or an allergen exposure. We disagree with Dr. Epstein's editorial (2), which states that Salpeter and colleagues' meta-analysis proves the safety of β-blockade in persons with mild to moderate asthma. Salpeter and colleagues' findings do suggest that many persons with mild to moderate asthma can receive β-blockade for a relatively short time, but the question of safety over the long term has not been answered.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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