Respiratory effect of beta-blockers in people with asthma and cardiovascular disease: population-based nested case control studyReport as inadecuate




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BMC Medicine

, 15:18

First Online: 27 January 2017Received: 02 August 2016Accepted: 05 January 2017DOI: 10.1186-s12916-017-0781-0

Cite this article as: Morales, D.R., Lipworth, B.J., Donnan, P.T. et al. BMC Med 2017 15: 18. doi:10.1186-s12916-017-0781-0

Abstract

BackgroundCardiovascular disease CVD is a common comorbidity in people with asthma. However, safety concerns have caused heterogeneity in clinical guideline recommendations over the use of cardioselective beta-blockers in people with asthma and CVD, partly because risk in the general population has been poorly quantified. The aim of this study was to measure the risk of asthma exacerbations with beta-blockers prescribed to a general population with asthma and CVD.

MethodsLinked data from the UK Clinical Practice Research Datalink was used to perform nested case-control studies among people with asthma and CVD matched on age, sex and calendar time. Adjusted incidence rate ratios IRR were calculated for the association between oral beta-blocker use and moderate asthma exacerbations rescue oral steroids or severe asthma exacerbations hospitalisation or death using conditional logistic regression.

ResultsThe cohort consisted of 35,502 people identified with active asthma and CVD, of which 14.1% and 1.2% were prescribed cardioselective and non-selective beta-blockers, respectively, during follow-up. Cardioselective beta-blocker use was not associated with a significantly increased risk of moderate or severe asthma exacerbations. Consistent results were obtained following sensitivity analyses and a self-controlled case series approach. In contrast, non-selective beta-blockers were associated with a significantly increased risk of moderate asthma exacerbations when initiated at low to moderate doses IRR 5.16, 95% CI 1.83–14.54, P = 0.002, and both moderate and severe exacerbations when prescribed chronically at high dose IRR 2.68, 95% CI 1.08–6.64, P = 0.033 and IRR 12.11, 95% CI 1.02–144.11, P = 0.048, respectively.

ConclusionsCardioselective beta-blockers prescribed to people with asthma and CVD were not associated with a significantly increased risk of moderate or severe asthma exacerbations and potentially could be used more widely when strongly indicated.

KeywordsAsthma Cardiovascular disease Beta-blocker Drug safety Pharmacovigilance AbbreviationsCIconfidence interval

COPDchronic obstructive pulmonary disease

CVDcardiovascular disease

FEV1forced expiratory volume in 1 second

HEShospital episodes statistics

ICDInternational Classification of Disease

ICSinhaled corticosteroid

IRRincidence rate ratio

LABAlong-acting beta2-agonist

ONSOffice for National Statistics

SABAshort-acting beta2-agonist

Electronic supplementary materialThe online version of this article doi:10.1186-s12916-017-0781-0 contains supplementary material, which is available to authorized users.





Author: Daniel R. Morales - Brian J. Lipworth - Peter T. Donnan - Cathy Jackson - Bruce Guthrie

Source: https://link.springer.com/







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