Safety of Beta-Blockers in Respiratory Disease

These are cautiously used in those with issues like COPD or asthma

A man using a Metered-Dose Inhaler
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Beta-blockers are a type of medication used in the treatment of heart disease and hypertension (high blood pressure). However, your medical team may be cautious about prescribing beta-blockers for you if you have a respiratory condition such as asthma or chronic obstructive pulmonary disease (COPD) because of an increased risk of experiencing harmful side effects, such as shortness of breath or an exacerbation of other respiratory symptoms.

What's tricky about this is that it is common to have both heart disease and pulmonary (lung) disease—and beta-blockers are often beneficial even when you have both conditions. In some cases, your doctor may prescribe a beta-blocker and ask you to watch out for and report any side effects that you experience. In others, newer drug options may be more appropriate.

What Beta-Blockers Do

Beta-blockers, also known as beta-adrenergic receptor blockers, decrease heart rate and blood pressure. This is helpful if you have hypertension and/or heart failure. Beta-blockers are often used to reduce the risk of a heart attack in people who have heart disease. In some instances, beta-blockers are used for preventing migraines.

These prescription drugs block the effects of epinephrine, the hormone responsible for increasing heart rate and raising blood pressure. By binding to molecules on the surface of the heart and blood vessels—known as beta-1 receptors—beta-blockers decrease the effects of epinephrine. As a result, the heart rate is slowed, the force of heart contractions is reduced, and blood pressure is decreased.

Use With Respiratory Disease

Beta-blockers can be beneficial to those with lung disease for several reasons:

  • They can help maintain optimal blood pressure and heart function, helping you avoid dyspnea (shortness of breath).
  • COPD is associated with an increased risk of heart failure, which beta-blockers can help treat.
  • Heart disease is a leading cause of death among people who have pulmonary disease, and these drugs can reduce that risk.
  • Beta-blockers can enhance the effects of inhaled albuterol and salbutamol, two staples of asthma and COPD therapy.

These benefits, however, must be carefully weighed against notable risks.

Pulmonary Side Effects

The problem with using beta-blockers if you have lung disease is that beta receptors are also found in lung tissue. When epinephrine binds to beta receptors in the lungs, the airways relax (open). That is why you might use an EpiPen to treat a respiratory emergency.

Beta-blockers cause the airways in the lungs to contract (narrow), making it difficult to breathe. This isn't usually a problem unless you already have blockage or narrowing in your airways from lung disease.

Respiratory side effects of beta-blockers can include:

If you experience any of these issues, it is important that you discuss your symptoms with your doctor. Sometimes, a dose reduction can alleviate the medication side effects. Get immediate medical attention if you experience severe symptoms.

Cardioselective Beta-Blockers

Beta-blockers can affect beta-1 and beta-2 receptors. In general, beta-1 receptors are more prevalent in the heart, while beta-2 receptors are more prevalent in the lungs.

Newer, second-generation beta-blockers are considered cardioselective, as they have a greater affinity for beta-1 receptors. Second generation beta-blockers include:

  • Brevibloc (esmolol)
  • Tenorman (atenolol)
  • Toprol XL (metoprolol succinate)
  • Zebeta (bisoprolol fumarate)

Generally speaking, cardioselective beta-blockers are considered safer if you have a pulmonary disease, such as asthma or COPD.

First-generation beta-blockers are non-selective—they block both beta-1 and beta-2 receptors. These include:

  • Inderal (propranolol)
  • Trandate (labetalol)
  • Corgard (nadolol)

Risks

Be aware that while selective beta-blockers are not as likely to cause pulmonary side effects as non-selective beta-blockers, they can cause pulmonary side effects, especially at high doses. When taking these drugs, you may experience shortness of breath, wheezing, asthma or COPD exacerbation, or more subtle respiratory effects that can be measured with diagnostic tests.

Cardioselective beta-blockers may reduce forced expiratory volume (FEV1). This is more common when you first start taking them. FEV1 is a measure of the volume of air that you can expire with maximal effort in one second. In most cases, the FEV1 will normalize within a week or two once your body adapts to the drug.

A Word From Verywell

While cardioselective beta-blockers are available, your medical team will work with you to tailor your treatment to your specific needs—and you may need a prescription for a non-cardioselective beta-blocker. Keep in mind that people react differently to different drugs, so it is important that you watch for any new respiratory symptoms, such as changes in your breathing pattern or any increases in the severity or frequency of your exacerbations.

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