Why does metoprolol cause bronchospasm

In this study, metoprolol appeared to raise risk for a severe COPD exacerbation; given that metoprolol did not worsen FEV 1 , the reason for this outcome is unclear.

Dransfield MT et al. Metoprolol for the prevention of acute exacerbations of COPD. N Engl J Med Oct 20; [e-pub]. N Engl J Med Oct 20 A randomized trial did not confirm observational data suggesting that these drugs benefit patients with chronic obstructive pulmonary disease. Comment In this study, metoprolol appeared to raise risk for a severe COPD exacerbation; given that metoprolol did not worsen FEV 1 , the reason for this outcome is unclear.

Brett, MD, at time of publication Nothing to disclose. That is why you might use an EpiPen to treat a respiratory emergency.

Beta-blockers cause the airways in the lungs to contract narrow , making it difficult to breathe. This isn't usually a problem unless you already have blockage or narrowing in your airways from lung disease.

Respiratory side effects of beta-blockers can include:. If you experience any of these issues, it is important that you discuss your symptoms with your healthcare provider. Sometimes, a dose reduction can alleviate the medication side effects. Get immediate medical attention if you experience severe symptoms. Beta-blockers can affect beta-1 and beta-2 receptors. In general, beta-1 receptors are more prevalent in the heart, while beta-2 receptors are more prevalent in the lungs. Newer, second-generation beta-blockers are considered cardioselective, as they have a greater affinity for beta-1 receptors.

Second generation beta-blockers include:. Generally speaking, cardioselective beta-blockers are considered safer if you have a pulmonary disease, such as asthma or COPD.

First-generation beta-blockers are non-selective—they block both beta-1 and beta-2 receptors. These include:. Be aware that while selective beta-blockers are not as likely to cause pulmonary side effects as non-selective beta-blockers, they can cause pulmonary side effects, especially at high doses. When taking these drugs, you may experience shortness of breath, wheezing, asthma or COPD exacerbation, or more subtle respiratory effects that can be measured with diagnostic tests.

Cardioselective beta-blockers may reduce forced expiratory volume FEV1. This is more common when you first start taking them. Patients continued their inhaled steroids and were also given tiotropium, presumably as a safety measure. At trial's end, there were no significant differences between groups in airway hyperresponsiveness or asthma symptoms, although there was a 2.

Beta blockers are a key component of care for people who have had previous heart attacks or who have systolic heart failure. Three beta blockers have demonstrated a survival benefit in systolic heart failure: the cardioselective agents metoprolol XL and bisoprolol, and the noncardioselective carvedilol. It seems unlikely that the risks of worsening asthma or COPD outweigh the potential benefits of beta blocker use, in these patients.

Beta blockers have not been proven beneficial in randomized trials for stable coronary artery disease primary prevention in people without a previous myocardial infarction or who have risk factors. The theorized benefit among these patients drives the vast majority of beta-blocker prescriptions, but there is today no evidence-based imperative for this practice.

What's more interesting is the question of whether chronic beta blocker use might actually improve asthma or COPD, as mounting observational evidence suggests. The selectivity of beta-adrenoceptor antagonists at the human beta1, beta2 and beta3 adrenoceptors.

California; SIGN Edinburgh; National Asthma Education and Prevention Program. Expert panel report 3 EPR-3 : Guidelines for the diagnosis and management of asthma-summary report Allergy Clin. Melbourne; Ichinose, M. Japanese guidelines for adult asthma Pujet, J. Effects of celiprolol, a cardioselective beta-blocker, on respiratory function in asthmatic patients. Schindl, R.

The effect of the cardioselective beta blocker celiprolol on pulmonary function in asthmatic patients. Lainscak, M. Differences between bisoprolol and carvedilol in patients with chronic heart failure and chronic obstructive pulmonary disease: a randomized trial.

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Reprints and Permissions. Huang, KY. Do beta-adrenergic blocking agents increase asthma exacerbation? A network meta-analysis of randomized controlled trials. Sci Rep 11, Download citation. Received : 16 July Accepted : 07 December Published : 11 January Anyone you share the following link with will be able to read this content:.

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Download PDF. Subjects Disease prevention Respiratory tract diseases. Abstract Beta-adrenergic blocking agents abbreviated as beta-blockers have been used for treating various cardiovascular diseases. Introduction 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.

Methods The detailed description of method is listed in eTable 1. Results After the initial screening procedure, a total of articles were considered for full-text review Fig. Figure 1. Flowchart of the current network meta-analysis. Full size image.

Figure 2. Table 1 League table of association between asthma exacerbation and beta-blocking agent prescription: overall. Full size table. Figure 3. Table 2 League table of association between asthma exacerbation and beta-blocking agent prescription: sensitivity test of removal of zero event. Table 3 League table of association between asthma exacerbation and beta-blocking agent prescription: patients with baseline asthma. Discussion To the best of our knowledge, this is the first NMA addressing the risk of asthma attack in conjunction with different beta-blocker treatments in the general and asthma population.

Conclusion This study showed that oral timolol and infusion of propranolol were associated with a significant risk of developing asthma attacks in patients with or without asthma history.

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