asthma and beta blockers

[johnep]

Pt came in today clutching a box of 25mg Atenolol and a symbicort.

Showed me the symbicort PIL where it cautioned re beta blockers. Stockley nowhere to be found. He wanted to know if symbicort would harm him if taken with his atenolol which he had been on for two years.

I reassured him and asked why he was having the symbicort, oh says he, I have been wheezing and the Dr thought this would do me good. I thought that ordinary ventolin would have been sufficient.

I also mentioned receptors in lungs for beta blockers and although atenolol was cardioselective, always a possibility that had affected his lungs.

I ended suggesting that he tried the symbicort if he wheezed and check with his Dr next visit--Monday.

Scurrying back into the dispensary I checked the BNF and I could not really find any specific reference to atenolol in asthma., mention of non selective beta blockers as far as I could see.

I am sure you will put me right.

Looks as CPD is required.
johnep

[Nik]

BNF interactions mentions nothing regarding beta2 sympathomimetics and beta blockers + nothing specific for atenolol either. Would still counsel patient if symptoms worsen to see doctor.

[emelianenko]

this is all that is mentioned the spc for symbicort also, dunno whether its of any help,

Beta-adrenergic blockers can weaken or inhibit the effect of formoterol. Symbicort should therefore not be given together with beta-adrenergic blockers (including eye drops) unless there are compelling reasons.

[Shwampa]

Usually the problem is inverse. Normally, you'll know earlier in your life if you have asthma before the circulatory problems and the dilemna is whether it's safe to give beta-blockers to asthmatics.

From Medscape Pharmacists
Ask the Experts about Pharmacotherapy
Should Patients With Asthma Receive Beta-Blockers for Heart Problems?
Posted 01/31/2008


Question
I have encountered many patients with asthma who are being treated with cardioselective beta-blockers for various indications such as hypertension or heart failure. Given the risk for bronchospasm associated with beta-blockers, should these patients be taking this medication?

Response from Darrell T. Hulisz, PharmD
Associate Professor, Department of Family Medicine, Case Western Reserve University School of Medicine, University Hospitals, Case Medical Center, Cleveland, Ohio



The question of whether to alter beta-blocker therapy in patients with asthma has been reviewed extensively in the medical literature.[1-5] Cardioselective (beta-1) beta-blockers are efficacious in the treatment of heart failure, hypertension, tachyarrhythmias, and post-myocardial infarction. However, concerns about nonselective agents such as propranolol inducing bronchospasm emerged in older case reports.[6] Some consensus reports have even advised against the use of nonselective beta-blockers, including ophthalmic formulations, in patients with asthma.[3] However, these reports do allow for patients with mild to moderate disease to be treated with a cardioselective beta-blocker, if necessary.

The decision to recommend discontinuing a beta-blocker or substituting one beta-blocker for another in a patient with asthma is multifactorial. If the patient's asthma is well controlled and he or she is receiving a cardioselective beta-blocker, it seems prudent to leave well enough alone.

The available evidence supports the position that beta-blockers should not be withheld from patients with asthma who are under good control and who have comorbid diseases where beta-blockers have been proven to reduce mortality.[1-5] A Cochrane review of 19 studies found that beta-blockers did not adversely affect respiratory function in the short term.[1] Long-term data are not as readily available. This information was also examined in a meta-analysis.[2]

It is important to consider that some of the studies included patients who were younger than those normally treated with beta-blockers. Dose is also a factor, as cardioselective beta-blockers lose their selectivity as the dose increases (raising the risk for bronchospasm). Most available data supporting the safety of beta-blockers in reactive lung disease relate to patients with mild to moderate disease.

In conclusion, beta-blockers should not be stopped in patients with reactive airway disease that is well controlled and who have comorbid cardiovascular diseases.[1-5] Careful monitoring of respiratory function is necessary, with cautious increases of dosage, especially if increased dosage is necessary for stabilizing a comorbid condition.[3] The overall mortality benefit in heart failure, myocardial infarction, arrhythmias, and hypertension outweighs the risk of beta-blocker therapy. That being said, when starting a new medication to treat a disease state such as hypertension, nonselective beta-blockers may not be the first choice for patients with asthma if other alternatives are available that also significantly reduce mortality. However, some disease states such as post-myocardial infarction may not offer an alternative to beta-blockers.[4,5]

[johnep]

Thanks guys, all reasonably clear now. The pts always think that an interaction is going to harm them, never that most mean action of one item is reduced or enhanced.
johnep