Durandet P, Gosse P, Vergeret J, Taytard A
Service de Pneumologie, Hôpital du Haut-Lévêque, Centre Hospitalo-Universitaire de Bordeaux, Pessac.
Rev Mal Respir. 1989;6(2):127-32.
The respiratory tolerance can limit the use of beta-blocker medication (beta-) currently indicated in numerous clinical situations, both cardiovascular and also neurological and ophthalmological. Blockade of beta adrenergic receptors is without risk in subjects free of bronchial pathology, but may destabilize underlying airflow obstruction; either presenting as or sustaining bronchospasm in an asthmatic, and increasing bronchial obstruction, in patients suffering from chronic airflow obstruction (BPCO). Now BPCO, and in particular asthma, are easily associated with diseases for which beta- are indicated. In addition the notion of cardioselectivity is relative and dose dependent.
beta- are contraindicated in chronic airflow obstruction with bronchial hyper-reactivity; in other cases, beta- should be used carefully choosing the most cardioselective products at the lowest effective dose. Whatever the route of administration (in particular eye drops), the beta- are reliable to produce the same harmful effects. There should be strict follow up of treatment and a watch kept for signs of a worsening or a provocation of respiratory problems; conversely the occurrence of such symptomatology in a patient with bronchial pathology should call into question the place of beta-. Finally beta- should be avoided in allergic subjects and (a fortiori) in specific immunotherapy where there is a possibility of anaphylactic shock.
呼吸耐受性可能会限制β受体阻滞剂（β-）在目前众多临床情况下的使用，这些临床情况涉及心血管、神经和眼科领域。在没有支气管病变的受试者中，阻断β肾上腺素能受体没有风险，但可能会使潜在的气流阻塞不稳定；在哮喘患者中可能引发或持续支气管痉挛，在患有慢性气流阻塞（慢性阻塞性肺疾病，BPCO）的患者中会加重支气管阻塞。现在，慢性阻塞性肺疾病，尤其是哮喘，很容易与需要使用β-受体阻滞剂的疾病相关联。此外，心脏选择性的概念是相对的且取决于剂量。
β-受体阻滞剂在伴有支气管高反应性的慢性气流阻塞中是禁忌的；在其他情况下，应谨慎使用β-受体阻滞剂，选择最具心脏选择性的产品并使用最低有效剂量。无论给药途径如何（特别是眼药水），β-受体阻滞剂都可能产生相同的有害影响。应严格随访治疗情况，并密切关注呼吸问题恶化或引发的迹象；相反，在患有支气管病变的患者中出现此类症状应质疑β-受体阻滞剂的使用。最后，在过敏受试者中应避免使用β-受体阻滞剂，在可能发生过敏性休克的特异性免疫治疗中（更不用说）也应避免使用。
