Shelley R. Salpeter, MD; Thomas M. Ormiston, MD; Edwin E. Salpeter, PhD
Acknowledgments: The authors thank Steve Milan for guidance with the Cochrane review, Toby Lasserson for technical assistance, and Karen Blackhall for coordinating the trials search.
Requests for Single Reprints: Shelley Salpeter, MD, Department of Medicine, Santa Clara Valley Medical Center, 751 South Bascom Avenue, San Jose, CA 95128; e-mail, firstname.lastname@example.org.
Current Author Addresses: Dr. S. Salpeter: Department of Medicine, Santa Clara Valley Medical Center, 751 South Bascom Avenue, San Jose, CA 95128.
Dr. Ormiston: Santa Clara Valley Medical Center, 751 South Bascom Avenue, San Jose, CA 95128.
Dr. E. Salpeter: Center for Radiophysics and Space Research, Cornell University, 612 Space Sciences Building, Ithaca, NY 14853.
Author Contributions: Conception and design: S.R. Salpeter, T.M. Ormiston.
Analysis and interpretation of the data: S.R. Salpeter, T.M. Ormiston, E.E. Salpeter.
Drafting of the article: S.R. Salpeter, T.M. Ormiston.
Critical revision of the article for important intellectual content: S.R. Salpeter, T.M. Ormiston.
Final approval of the article: S.R. Salpeter, T.M. Ormiston, E.E. Sal-peter.
Provision of study materials or patients: S.R. Salpeter, T.M. Ormiston.
Statistical expertise: E.E. Salpeter.
Collection and assembly of data: S.R. Salpeter, T.M. Ormiston.
To assess the effect of cardioselective β-blockers on respiratory function of patients with reactive airway disease.
Comprehensive searches of the EMBASE, MEDLINE, and CINAHL databases from 1966 to May 2001 and scanning of references of the identified articles and related reviews.
Randomized, blinded, placebo-controlled trials that studied the effects of cardioselective β-blockers on FEV1, symptoms, and the use of inhaled β2-agonists in patients with reactive airway disease were selected. Interventions studied were the administration of a cardioselective β-blocker and administration of β2-agonist after the study drug.
Outcomes measured were the change in FEV1 from baseline, the number of patients with respiratory symptoms, and the use of inhaled β2-agonists with active treatment compared with placebo.
Nineteen studies on single-dose treatment and 10 studies on continued treatment were included. Administration of a single dose of a cardioselective β-blocker was associated with a 7.46% (95% CI, 5.59% to 9.32%) decrease in FEV1 and a 4.63% (CI, 2.47% to 6.78%) increase in FEV1 response to β-agonist compared with placebo, with no increase in symptoms. Trials lasting from 3 days to 4 weeks produced no significant change in FEV1 (−0.42% [CI, −3.74% to 2.91%]), symptoms, or inhaler use compared with placebo but maintained an 8.74% (CI, 1.96% to 15.52%) increase in β-agonist response. No significant treatment effect in terms of FEV1 was found in patients with concomitant chronic obstructive pulmonary disease, whether single doses (change in FEV1, −5.28% [CI, −10.03% to −0.54%]) or continued treatment (change in FEV1, 1.07% [CI, −3.3% to 5.44%]) was given.
Cardioselective β-blockers do not produce clinically significant adverse respiratory effects in patients with mild to moderate reactive airway disease. The results were similar for patients with concomitant chronic airways obstruction. Given their demonstrated benefit in such conditions as heart failure, cardiac arrhythmias, and hypertension, cardioselective β-blockers should not be withheld from patients with mild to moderate reactive airway disease.
Although β-blockers improve clinical outcomes in many patients with cardiovascular disease, clinicians sometimes avoid these agents in patients with concomitant lung disease because they fear precipitation of acute bronchospasm.
This meta-analysis of 29 randomized trials shows that cardioselective-blockers (β1-blockers), given for a few days to a few weeks, do not significantly worsen pulmonary function or respiratory symptoms and do not lead to increased use of inhalers in patients with mild to moderate reactive (reversible) airway disease.
The studies in this meta-analysis were short, evaluated only cardioselective β-blockers, and did not include patients with severe or irreversible airway disease.
Effects of treatment on FEV1 for single-dose studies.PPPPPP
Effects of treatment after use of β2-agonists on FEV1 for single-dose studies.PPPPPP
Effects of treatment on FEV1 for continued treatment studies.PP =PPP
Effects of treatment after use of β2-agonists on FEV1 for continued treatment studies.PP =P >PP =
Appendix Table. Characteristics of Included Studies
Results of search for and selection of trials.
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Salpeter SR, Ormiston TM, Salpeter EE. Cardioselective β-Blockers in Patients with Reactive Airway Disease: A Meta-Analysis. Ann Intern Med. 2002;137:715–725. doi: 10.7326/0003-4819-137-9-200211050-00035
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Published: Ann Intern Med. 2002;137(9):715-725.
Asthma, Pulmonary/Critical Care.
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