The safety of cardio-selective beta1-blockers in asthma: literature review and search of global pharmacovigilance safety reports

Beta-blockers are key in the management of cardiovascular diseases, but blocking airway beta2-receptors can cause severe and sometimes fatal bronchoconstriction in people with asthma. Although cardio-selective beta1-blockers may be safer than non-selective beta-blockers, they remain relatively contraindicated and under-prescribed. We review the evidence of the risk associated with cardio-selective beta1-blocker use in asthma.MethodsWe searched “asthma” AND “beta-blocker” in PubMed and EmbaseOvid from start to May 2020. The World Health Organisation global database of individual case safety reports (VigiBase) was searched for reports of fatal asthma or bronchospasm and listed cardio-selective beta1-blockers use (accessed February 2020). Reports were examined for evidence of pre-existing asthma.ResultsPubMed and EmbaseOvid searches identified 304 and 327 publications respectively. No published reports of severe or fatal asthma associated with cardio-selective beta1-blockers were found. Three large observational studies reported no increase in asthma exacerbations with cardio-selective beta1-blocker treatment. The VigiBase search identified five reports of fatalities in patients with pre-existing asthma and reporting asthma or bronchospasm during cardio-selective beta1-blocker use. Four of these deaths were unrelated to cardio-selective beta1-blocker use. The circumstances of the fifth death were unclear.ConclusionsThere were no published reports of cardio-selective beta1-blockers causing asthma death. Observational data suggest that cardio-selective beta1-blocker use is not associated with increased asthma exacerbations. We found only one report of an asthma death potentially caused by cardio-selective beta1-blockers in a patient with asthma in a search of VigiBase. The reluctance to use cardio-selective beta1-blockers in people with asthma is not supported by this evidence.

ACUTE ASTHMA, PROGNOSIS, AND TREATMENT

Background: Asthma is a major health problem affecting all ages that increase the mortality rate worldwide. Early detection of its signs and symptoms are essential to control and maintain the disease and effective treatments are administrated, such as; ?-agonists and corticosteroids. The current review is about acute asthma, prognosis, and treatment. Methods: Scientific articles that linked to the present topic were obtained using an online searching process. The searching process included different scientific websites such as Google Scholar and PubMed. We obtained 16 articles that matched with the current subject and written in English. Of those 16 articles, 4 were excluded as they published before 2000, or mayn’t focusing on the present topic, or written in a language other than English; therefore, only 12 papers were included, and they were published till 2020. Results: Articles were selected according to the inclusion criteria that we selected, and then the discussion of the subject was performed under the main titles. Conclusion: Asthma is one of the most chronic inflammatory disease that increased the mortality rate worldwide. Asthma could affect 300 million individuals and account for one death among 250 death cases. All patients admitted with asthma exacerbation should be assessed promptly through detecting and recognition worsening signs and symptoms. The initial treatment includes oxygen administration, Short-acting ?-agonist, and systematic corticosteroids. Decreasing the severity of asthma exacerbations by improving daily therapy for asthma, controlling environmental triggers, and increasing patient education toward asthma risks and how they recognize its symptoms and seek for health care help. Keywords: Asthma exacerbations, ?-agonist, corticosteroids, differential diagnosis, fatal and non-fatal asthma.