Chest
Original Research: AsthmaAdverse Respiratory Effect of Acute β-Blocker Exposure in Asthma: A Systematic Review and Meta-analysis of Randomized Controlled Trials
Section snippets
Materials and Methods
A systematic review of MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) databases was performed using a prespecified protocol and search strategy (e-Tables 1, 2) to identify all randomized, blinded, placebo-controlled clinical trials published on or before January 20, 2013, evaluating acute β-blocker exposure (up to 7 days) in asthma. References and full texts were independently screened by a minimum of two reviewers, with agreement based on consensus. References of
Results
Of 1,989 references screened, 32 studies were included (Fig 1, e-Table 37, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41). A total of 16 studies evaluated selective β-blockers, six studies evaluated nonselective β-blockers, and 10 studies evaluated both. No randomized blinded placebo-controlled trials evaluating topical β-blockers in unselected patients were found. For selective β-blockers, 23 studies
Discussion
Acute selective β-blockade in the doses given caused statistically significant mean reductions in FEV1, nonsignificant increases in symptoms, and significant absolute falls in FEV1 of ≥ 20% (affecting 13% of subjects). For mean changes in FEV1 and symptoms, findings were similar to a previous meta-analysis, which evaluated selective β-blockers only and did not include fall in FEV1 of ≥ 20% as an outcome.3 Our findings suggest that, although the mean effects of acute selective β-blockade are
Acknowledgments
Author contributions: Dr Morales is guarantor of the data.
Dr Morales: contributed to conceiving the idea, study design, interpretation of the findings, data analysis, drafting of the manuscript, and approving the final draft.
Dr Jackson: contributed to conceiving the idea, study design, interpretation of the findings, drafting of the manuscript, and approving the final draft.
Dr Lipworth: contributed to study design, interpretation of the findings, drafting of the manuscript, and approving the
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Funding/Support: This study was funded by a Scottish Government Chief Scientist Office Clinical Academic Fellowship, which provided research costs and support for Dr Morales [Grant CAF/11/07].
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