Cardioselective β-Blockers in Patients with Reactive Airway Disease

OBJECTIVE: To assess the effect of cardioselective beta-blockers on respiratory function of patients with reactive airway disease. DATA SOURCES: 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. STUDY SELECTION: Randomized, blinded, placebo-controlled trials that studied the effects of cardioselective beta-blockers on FEV1, symptoms, and the use of inhaled beta2-agonists in patients with reactive airway disease were selected. Interventions studied were the administration of a cardioselective beta-blocker and administration of beta2-agonist after the study drug. DATA EXTRACTION: Outcomes measured were the change in FEV1 from baseline, the number of patients with respiratory symptoms, and the use of inhaled beta2-agonists with active treatment compared with placebo. DATA SYNTHESIS: Nineteen studies on single-dose treatment and 10 studies on continued treatment were included. Administration of a single dose of a cardioselective beta-blocker was associated with a 7.46% (95% CI, 5.59% to 9.32%) decrease in FEV(1) and a 4.63% (CI, 2.47% to 6.78%) increase in FEV1 response to beta-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 beta-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. CONCLUSIONS: Cardioselective beta-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 beta-blockers should not be withheld from patients with mild to moderate reactive airway disease.