Effects of Esmolol on Airway Function in Patients with Asthma

Abstract

In a double-blind, randomized, crossover study in ten patients with asthma, the effects on specific airway resistance of esmolol, a new ultra-short-acting beta 1-selective adrenoceptor blocker, were compared with those of placebo. Specific airway resistance was measured during increasing doses of esmolol infusion, during dry air provocation tests, and following isoproterenol inhalation. These same studies were later carried out on six of ten patients following intravenous propranolol infusion. All patients were able to tolerate the maximum dose of esmolol (300 micrograms/kg/min); treatment differences between esmolol and placebo were not found. In contrast, intravenous propranolol produced marked symptomatic bronchoconstriction after the lowest dose (1 mg) in two of six patients. Esmolol produced slight but statistically significant enhancement of patients' sensitivity to dry air provocation. Similarly, a slight but significant inhibition of bronchomotor sensitivity to isoproterenol was noted during esmolol infusion. After infusion of 5 mg of intravenous propranolol, one of four patients had a clinically significant increase in sensitivity to dry air. It is concluded that esmolol, because of its short duration of action and relative lack of effect on airway resistance, may be preferred over propranolol in patients with asthma who require treatment with an intravenous beta-blocking agent.

Beta-1 selective adrenergic antagonist landiolol and esmolol can be safely used in patients with airway hyperreactivity

“…24,[40][41][42] The results of this study revealed that neither esmolol nor landiolol had a significant effect on the incidence of tracheal intubation-induced bronchoconstriction, and that the infusion of these betablockers during induction of anesthesia was beneficial for surgical patients with coronary risks by suppression of intubation-induced tachyarrhythmias. Sheppard et al 16 and Gold et al 17 demonstrated that esmolol had little effect on respiratory function in awake patients by measuring specific airway resistance and forced expiratory volume in 1 second/peak flow in awake patients with asthma and COPD, respectively, a finding that is consistent with the results of our study. In patients with bronchial hyperreactivity, airway instrumentation by tracheal intubation may evoke life-threatening bronchospasm and perioperative complications, resulting in the requirement of prolonged intensive care treatment.…”

“…Xanthine derivatives (15) Xanthine derivatives (11) Steroid inhalation (8) Steroid inhalation (7) Steroid inhalation (10) Leukotriene antagonist (15) Leukotriene antagonist (16) Leukotriene antagonist (14) Beta-stimulant inhalation (8) Beta-stimulant inhalation (5) Beta-stimulant inhalation (6) Each value is the mean Ϯ standard deviation of 20 patients. No statistical differences were found among the three groups.…”

“…[4][5][6][7][8][9][10][11] On the other hand, it was recently reported that cardioselective beta-blockers could be safely used for patients with airway hyperreactivity with concomitant heart failure or history of myocardial infarction. [12][13][14] The ultra-short-acting beta-1 selective adrenergic antagonist esmolol is now widely used to control tachycardia/tachyarrhythmia perioperatively, 15 and it has been established that this agent, because of its short duration of action and relative lack of effect on airway resistance, might be preferred over propranolol in awake patients with asthma 16 and COPD 17 who require treatment with an intravenous (IV) beta-blocking agent. Recently, the novel ultra-short-acting beta-1 selective adrenergic antagonist landiolol has also become available for control of tachycardia/tachyarrhythmia perioperatively 18 ; however, the safety of this agent has not yet been confirmed in patients with airway hyperreactivity perioperatively.…”

Esmolol is noninferior to metoprolol in achieving a target heart rate of 65 beats/min in patients referred to coronary CT angiography: A randomized controlled clinical trial

“…However, it has been demonstrated previously that esmolol is safe in bronchospastic diseases. 23 There are some limitations of our study we have to consider. This is a single-center study; therefore, the efficacy and safety of the described esmolol bolus protocol has to be evaluated in a multicenter randomized controlled trial.…”

Beta-Blockers after Myocardial Infarction: Do Benefits Ever Outweigh Risks in Asthma?

“…In the setting of an acute MI, esmolol, a short-acting β-blocker, appears to be generally safe and effective [50, 51, 52]. Because of its short half-life (approximately 10 min), in the small percentage of patients who may experience bronchospasm, it can be discontinued and adverse events effectively managed.…”