Bennett Miriam, Chang Catherina L, Tatley Michael, Savage Ruth, Hancox Robert J
Respiratory Research Unit, Dept of Respiratory Medicine, Waikato Hospital, Hamilton, New Zealand.
New Zealand Pharmacovigilance Centre, Division of Health Sciences, University of Otago, Dunedin, New Zealand.
ERJ Open Res. 2021 Mar 1;7(1). doi: 10.1183/23120541.00801-2020. eCollection 2021 Jan.
Beta-blockers are key in the management of cardiovascular diseases but blocking airway β-receptors can cause severe and sometimes fatal bronchoconstriction in people with asthma. Although cardioselective β-blockers may be safer than non-selective β-blockers, they remain relatively contraindicated and under-prescribed. We review the evidence of the risk associated with cardioselective β-blocker use in asthma.
We searched "asthma" AND "beta-blocker" in PubMed and EmbaseOvid from start to May 2020. The World Health Organization (WHO) global database of individual case safety reports (VigiBase) was searched for reports of fatal asthma or bronchospasm and listed cardioselective β-blocker use (accessed February 2020). Reports were examined for evidence of pre-existing asthma.
PubMed and EmbaseOvid searches identified 304 and 327 publications, respectively. No published reports of severe or fatal asthma associated with cardioselective β-blockers were found. Three large observational studies reported no increase in asthma exacerbations with cardioselective β-blocker treatment. The VigiBase search identified five reports of fatalities in patients with pre-existing asthma and reporting asthma or bronchospasm during cardioselective β-blocker use. Four of these deaths were unrelated to cardioselective β-blocker use. The circumstances of the fifth death were unclear.
There were no published reports of cardioselective β-blockers causing asthma death. Observational data suggest that cardioselective β-blocker use is not associated with increased asthma exacerbations. We found only one report of an asthma death potentially caused by cardioselective β-blockers in a patient with asthma in a search of VigiBase. The reluctance to use cardioselective β-blockers in people with asthma is not supported by this evidence.
β受体阻滞剂是心血管疾病管理的关键药物，但阻断气道β受体会在哮喘患者中引起严重的、有时甚至是致命的支气管收缩。尽管心脏选择性β受体阻滞剂可能比非选择性β受体阻滞剂更安全，但它们仍然相对禁忌且处方量不足。我们综述了与在哮喘中使用心脏选择性β受体阻滞剂相关风险的证据。
我们在PubMed和EmbaseOvid中从开始到2020年5月搜索了“哮喘”和“β受体阻滞剂”。在世界卫生组织（WHO）个体病例安全报告全球数据库（VigiBase）中搜索致命哮喘或支气管痉挛报告以及列出的心脏选择性β受体阻滞剂使用情况（于2020年2月获取）。检查报告以寻找既往存在哮喘的证据。
PubMed和EmbaseOvid搜索分别识别出304篇和327篇出版物。未发现与心脏选择性β受体阻滞剂相关的严重或致命哮喘的已发表报告。三项大型观察性研究报告称，心脏选择性β受体阻滞剂治疗并未增加哮喘发作次数。VigiBase搜索识别出五例既往存在哮喘且在使用心脏选择性β受体阻滞剂期间报告哮喘或支气管痉挛的患者死亡报告。其中四例死亡与使用心脏选择性β受体阻滞剂无关。第五例死亡情况不明。
尚无关于心脏选择性β受体阻滞剂导致哮喘死亡的已发表报告。观察性数据表明，使用心脏选择性β受体阻滞剂与哮喘发作增加无关。在搜索VigiBase时，我们仅发现一例可能由心脏选择性β受体阻滞剂导致哮喘患者死亡的报告。该证据不支持在哮喘患者中不愿使用心脏选择性β受体阻滞剂的观点。
