Abstract
Beta-adrenergic blocking agents (abbreviated as beta-blockers) have been used for treating various cardiovascular diseases. However, the potential for asthma exacerbation is one of the major adverse effects of beta-blockers. This study aimed to compare the level of risk for an asthma attack in patients receiving various beta-blockers. We searched for randomized controlled trials (RCTs) of either placebo-controlled or active-controlled design. The current network meta-analysis (NMA) was conducted under a frequentist model. The primary outcome was the incidence of asthmatic attack. A total of 24 RCTs were included. Overall NMA revealed that only oral timolol [risk ratio (RR) = 3.35 (95% confidence interval (CI) 1.04–10.85)] and infusion of propranolol [RR = 10.19 (95% CI 1.29–80.41)] were associated with significantly higher incidences of asthma attack than the placebo, whereas oral celiprolol [RR = 0.39 (95% CI 0.04–4.11)], oral celiprolol and propranolol [RR = 0.46 (95% CI 0.02–11.65)], oral bisoprolol [RR = 0.46 (95% CI 0.02–11.65)], oral atenolol [RR = 0.51 (95% CI 0.20–1.28)], infusion of practolol [RR = 0.80 (95% CI 0.03–25.14)], and infusion of sotalol [RR = 0.91 (95% CI 0.08–10.65)] were associated with relatively lower incidences of asthma attack than the placebo. In participants with a baseline asthma history, in addition to oral timolol and infusion of propranolol, oral labetalol, oxprenolol, propranolol, and metoprolol exhibited significantly higher incidences of asthma attack than did the placebo. In conclusion, oral timolol and infusion of propranolol were associated with a significantly higher risk of developing an asthma attack in patients, especially in those with a baseline asthma history, and should be avoided in patients who present a risk of asthma.Trial registration: PROSPERO CRD42020190540.
Highlights
Beta-adrenergic blocking agents have been frequently used to treat various cardiovascular disorders such as hypertension, ischemic heart disease, cardiac arrhythmias, and congestive heart failure[1,2,3,4]
24 articles were included in the current study, among which 13 provided evidence related to patients with a definite baseline asthma history
In the subgroup Network meta-analysis (NMA) of patients with a baseline asthma history, besides oral timolol [risk ratio (RR) = 6.42] and infusion of propranolol [RR = 10.20], there were additional beta-blockers that were associated with a significantly higher incidence of asthma attack than the placebo or control groups, including oral labetalol [RR = 6.60], oral oxprenolol [RR = 5.15], oral propranolol [RR = 3.35], and oral metoprolol [RR = 3.03]
Summary
Beta-adrenergic blocking agents (or beta-blockers) have been frequently used to treat various cardiovascular disorders such as hypertension, ischemic heart disease, cardiac arrhythmias, and congestive heart failure[1,2,3,4]. There is considerable evidence for the effectiveness and benefits of beta-blockers in treating these diseases, the associated adverse events such as an asthma attack create a dilemma for physicians considering treatment with beta-blockers for patients with asthma. Salpeter et al reported that patients with reactive airway disease who received a single dose of cardioselective beta-blockers presented a 7.46% decrease in forced expiratory volume in one second (FEV1)[7]. Another population-based nested case–control study demonstrated that nonselective beta-blockers were associated with a significantly increased risk of asthma exacerbation[6]. We conducted a comprehensive NMA to compare the risk of developing an adverse asthma attack in patients receiving treatment with various beta-blockers
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