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Can I Take Beta Blockers if I Have Asthma?

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Updated June 11, 2008

Question: Can I Take Beta Blockers if I Have Asthma?
Answer:

Yes, provided that:

  1. You take the right beta blocker
  2. You start with a short period of use as a trial (4 to 6 weeks)
This question is common, and comes up because it is traditional wisdom –- both among patients and medical professionals –- that beta blockers generally shouldn’t be used in people with asthma or COPD (two forms of a more general type of disease process called reversible airway disease).

The rationale for this makes a lot of sense on the surface. Beta blockers target beta receptors and stop them from sending messages to various parts of the body. In the cardiovascular system, this is beneficial for people with high blood pressure and heart problems because a lot of beta receptors are both on blood vessels and in the heart itself. Blocking these “cardiovascular beta receptors” relaxes blood vessels, slows down the heart, and leads to an overall decrease in blood pressure and in the amount of work the heart has to do.

However, a lot of beta receptors are in the lungs and “airway structures” ( bronchi, bronchioles –- both are small passages that conduct air through the lungs). In these locations, active beta receptors help keep air passages relaxed and loose, which improves breathing. Blocking beta receptors here causes these airway structures to become more tense and constricted, which is dangerous for people with asthma, COPD, or other types of reversible airway disease. The important point, though, is that cardiovascular and airway beta receptors are actually a little bit different. Beta blockers aren’t very good at telling the two types apart and generally block both types about the same, which is bad.

However, some beta blockers have been specifically designed to target cardiovascular beta receptors while leaving airway beta receptors alone. Though they aren’t 100% selective, they usually do a good job discriminating between the two. These newer, cardiovascular beta receptor specific drugs are called cardioselective beta blockers.

Research suggests that not only are cardioselective generally safe for use in people with asthma and COPD, they may actually yield more benefit in those people (who tend to have higher cardiovascular risks).

If your doctor wants to try a cardioselective beta blocker, he should do an initial trial to make sure that everything is going to be ok. This trial period should last between 4 to 6 weeks. During this time, you should keep track of asthma attacks, any unusual difficulty breathing, or any other change in your respiratory (breathing) patterns/effort and report problems to your doctor.

If you experience serious problems (greatly increased number of attacks, frequent difficulty breathing), the beta blocker should be stopped. Even if the trial goes well, make sure you keep your fast-acting inhalers filled and accessible, and that you take any other medicines or treatments exactly as prescribed. During treatment, your asthma (or other airway disease) will require monitoring, and you should seek medical care immediately for any serious breathing problems.

Source:

Salpeter S, Ormiston T, Salpeter E, Wood-Baker R. Cardioselective beta-blockers for reversible airway disease. Cochrane Database of Systematic Reviews 2001, Issue 2. Art. No.: CD002992. DOI: 10.1002/14651858.CD002992.

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