Marko Monika, Pawliczak Rafał
Department of Immunopathology, Faculty of Medicine, Division of Biomedical Science, Medical University of Lodz, Lodz, Poland.
Front Physiol. 2025 Jul 25;16:1582740. doi: 10.3389/fphys.2025.1582740. eCollection 2025.
This study aimed to provide an updated assessment of the changes in respiratory function after β-adrenergic receptor antagonists (β-blockers) administration in asthma patients. The main assumption of the study was to use new methodological and statistical approaches not previously applied in this field in systematic reviews and meta-analyses.
To select studies, PubMed/Medline, Embase, ClinicalTrials.gov, and Cochrane Library were searched. Additionally, Google Scholar was searched for gray literature. A systematic review and meta-analysis for forced expiratory volume in 1 second (FEV) and peak expiratory flow rate in asthma patients after administration of cardio-selective and non-selective β-blockers compared to placebo or baseline was performed. We also assessed FEV after topical β-blocker application compared to baseline.
An independent subgroup analysis demonstrated significantly higher FEV in the placebo group (standardized mean difference [SMD] =-0.74, 95% confidence interval [CI]: 1.15, -0.34, P = 0.0003) than in non-selective β-blockers. The test for subgroup differences indicates that there is a statistically significant subgroup effect among cardio-selective and non-selective β-blockers (P = 0.03, = 80%). We also showed a statistically significant decrease in FEV (SMD = -0.70, 95% CI: [-1.56 to -0.03], P = 0.04) after topical β-blocker application.
Patients with asthma may tolerate cardio-selective β-blockers better than non-selective β-blockers. The FEV1 value depends on the type of β-blocker used. Cardio-selective β-blockers may be cautiously considered in patients with asthma only when strong cardiovascular indications exist (such as heart failure with reduced ejection fraction or post-myocardial infarction) and with appropriate monitoring. At the same time, less risky therapeutic options should be chosen instead of topical β-blockers.
https://www.crd.york.ac.uk/prospero/, identifier 42024606876.
本研究旨在对哮喘患者使用β肾上腺素能受体拮抗剂（β受体阻滞剂）后呼吸功能的变化进行最新评估。该研究的主要设想是在系统评价和荟萃分析中采用该领域此前未应用过的新方法和统计方法。
通过检索PubMed/Medline、Embase、ClinicalTrials.gov和Cochrane图书馆来筛选研究。此外，还通过谷歌学术搜索灰色文献。对哮喘患者在使用心脏选择性和非选择性β受体阻滞剂后与使用安慰剂或基线相比的1秒用力呼气量（FEV）和呼气峰值流速进行了系统评价和荟萃分析。我们还评估了局部应用β受体阻滞剂后与基线相比的FEV。
一项独立亚组分析显示，安慰剂组的FEV显著高于非选择性β受体阻滞剂组（标准化均值差[SMD]=-0.74，95%置信区间[CI]：1.15，-0.34，P=0.0003）。亚组差异检验表明，心脏选择性和非选择性β受体阻滞剂之间存在统计学显著的亚组效应（P=0.03，I²=80%）。我们还显示，局部应用β受体阻滞剂后FEV有统计学显著下降（SMD=-0.70，95%CI：[-1.56至-0.03]，P=0.04）。
哮喘患者对心脏选择性β受体阻滞剂的耐受性可能优于非选择性β受体阻滞剂。FEV1值取决于所用β受体阻滞剂的类型。仅在存在强烈心血管适应证（如射血分数降低的心力衰竭或心肌梗死后）且进行适当监测的情况下，才可以谨慎考虑在哮喘患者中使用心脏选择性β受体阻滞剂。同时，应选择风险较低的治疗方案而非局部应用β受体阻滞剂。
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