Beta-blockers therapy in asthma

Beta-blockers have been for years considered contraindicated in asthmatic patients. However, the beneficial effects in cardiovascular diseases, including reduction of mortality due to heart problems, make beta-blockers highly desired in patients suffering from ischemic heart disease or congestive heart failure. Most studies demonstrate that cardioselective beta-blockers, such as metoprolol or bisoprolol, may be considered for treatment of cardiovascular problems in mildmoderate asthmatic patients, whose asthma is fully controlled. It is recommended to start therapy with low doses, which are gradually increased. Moreover, in order to minimize the risk of bronchoconstriction pre-treatment with an inhaled long-acting beta-agonist should be considered before starting beta-blocker therapy. In an experimental asthma model, chronic administration of beta-blockers decreased airway hyperresponsiveness. Recent studies have demonstrated that chronic beta-blocker therapy is also beneficial in asthmatic patients, and leads to decreased bronchial reactivity to metacholine. Interestingly, in this case non-selective beta-blockers, such as nadolol, are more effective than cardioselective ones. This approach, however, remains an experimental procedure.