Beta adrenergic antagonists and antianginal drugs

Abstract

The Global Initiative for Asthma (GINA) guidelines acknowledge that beta-blockers can cause bronchospasm, however specific recommendations regarding patients with asthma in addition to a chronic condition warranting beta blocker therapy are absent beyond closely monitoring patients. A network meta-analysis was conducted to elucidate the risk of experiencing an asthma attack precipitated by beta blocker therapy. The primary outcome was the incidence of an asthma attack in patients with or without a past medical history of asthma and either receiving a beta blocker or placebo. A total of 24 articles comprising 1301 adult patients were included in the analysis. Patients had an average age of 54.5 (range 22.0-77.3) years and 22.6% of patients were female. Investigated beta blockers included oral propranolol, oral pindolol, oral atenolol, oral acebutolol, oral sotalol, oral metoprolol, oral practolol, oral oxprenolol, oral timolol, oral nadolol, infusion of sotalol, oral labetalol, oral bisoprolol, oral carvedilol, oral celiprolol, infusion of esmolol, infusion of propranolol, infusion of tolamolol, oral carteolol, infusion of propranolol and labetalol, infusion of practolol, oral celiprolol and propranolol, and oral bevantolol. The authors determined that oral timolol (RR ¼ 3.35, 95% CI 1.04-10.85) and infused propranolol (RR ¼ 10.19, 95% CI 1.29-80.41) were associated with a higher risk 219