An updated insight into the effect of β-adrenergic receptor antagonists (β-blockers) on respiratory function in asthma patients: a systematic review and meta-analysis

Abstract

Background: 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.

Methods: 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 (FEV₁) 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 FEV₁ after topical β-blocker application compared to baseline.

Results: An independent subgroup analysis demonstrated significantly higher FEV₁ 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, I ² = 80%). We also showed a statistically significant decrease in FEV₁ (SMD = -0.70, 95% CI: [-1.56 to -0.03], P = 0.04) after topical β-blocker application.

Conclusion: 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.

Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier 42024606876.

Keywords: FEV1; PEFR; asthma; beta-blockers; cardio-selective; non-selective; safety.

FIGURE 1

Flowchart of the screening procedure. PICOT: Population, Intervention, Comparison, Outcome and Study type.

FIGURE 2

Risk of bias assessment. (A) Risk of bias summary: Review authors’ judgements about each risk of bias item for each included study. (B) Risk of bias graph: Review authors’ judgments about each risk of bias item are presented as percentages across all included studies.

FIGURE 3

Standardized mean difference (SMD) for FEV₁. Cardio-selective and non-selective β-blockers. FEV₁: forced expiratory volume in 1 second.

FIGURE 4

Standardized mean difference (SMD) for FEV₁. Non-selective β-blockers in patients using salbutamol. FEV₁: forced expiratory volume in 1 second.

FIGURE 5

Standardized mean difference (SMD) for FEV₁. Cardio-selective β-blockers baseline and after treatment. FEV₁: forced expiratory volume in 1 second.

FIGURE 6

Standardized mean difference (SMD) for PEFR. Cardio-selective β-blockers compared to placebo. PEFR: peak expiratory flow rate.

FIGURE 7

Standardized mean difference (SMD) for FEV₁ and PEFR. (A) β-blocker comparison: atenolol and acebutolol, FEV₁. (B) β-blocker comparison: atenolol and metoprolol, FEV₁. (C) β-blocker comparison: metoprolol and acebutolol, FEV₁. (D) β-blocker comparison: atenolol and metoprolol, PEFR. (E) β-blocker comparison: propranolol and pindolol, FEV₁. FEV₁: forced expiratory volume in 1 second, PEFR: peak expiratory flow rate.

FIGURE 8

Standardized mean difference (SMD) for FEV₁. Topical β-blocker comparison, at baseline and after FEV₁: forced expiratory volume in 1 second.