Can You Take Beta-Blockers If You Have Asthma or COPD?

A man using a Metered-Dose Inhaler
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It has long been suggested that beta-blockers—drugs commonly used to treat hypertension and other cardiovascular conditions—may be problematic in people with severe asthma or chronic obstructive pulmonary disease (COPD). This was due in large part to studies from the 1970s and 1980s, which suggested that the drugs amplify the sensitivity of lung tissues and, by doing so, increased the risk of bronchial spasms. But many of those assertions have since been challenged, with most experts today agreeing that the benefits of beta-blockers far outweigh the potential consequences.

With the development of newer cardioselective beta-blockers, the risks are even less. Even so, care needs to be taken when beta-blockers are used in people with severe asthma or COPD to avoid potentially serious exacerbations.


Beta-blockers, also known as beta-adrenergic receptor blockers, ultimately decrease the amount of oxygen the heart needs to properly function.

They were once considered off-limits for people with reactive lung disease (RAD) due to their generalized mechanism of action. The drugs block the effects of epinephrine, the hormone responsible for increases in heart rate. By binding to molecules on the surface of the heart—known as beta-1 receptors—the drug prevents epinephrine from stimulating heart activity. Heart rate is slowed, the force of heart contractions is reduced, and blood pressure is decreased as a result.

The problem is that beta receptors are also found on lung tissue. The activation of these molecules, known as beta-2 receptors, causes air passages to relax under the influence of epinephrine. When blocked, the lung tissues can contract, causing air passages to narrow.

On the surface of things, these converse effects would suggest that beta-blockers are "harmful" to people with asthma or COPD, particularly since the some of drugs aren't adept at differentiating between beta-1 and beta-2 receptors. Recent research suggests that may not be the case, though.

Demonstrated Benefits

From the perspective of a person's overall health, while the use of beta-blockers may increase the risk of COPD exacerbations, the avoidance of beta blockers can pose a risk of death.

The reasons are simple: Heart disease is the leading cause of death among most ethnic populations in the United States, including African Americans, Hispanics, and whites. Among people with COPD, heart disease remains the primary cause of death. In fact, as an independent risk factor, COPD is associated with a three-fold increased risk of sudden heart failure compared to the general population.

Within this context, the use of beta-blockers not only reduces the risk of death in people with COPD, it can improve their quality of life. According to a 2014 review of 13 randomized studies, beta-blockers reduced the risk of death in people with COPD by 28 percent and the risk of exacerbations by 37 percent. Even among those with coronary heart disease or heart failure, beta-blockers were associated with a 36 percent and 26 percent reduction in the risk of death, respectively.

There is even evidence that beta-blockers can enhance the effects of inhaled albuterol and salbutamol, two staples of asthma and COPD therapy.

Most research today suggests that, by controlling blood pressure and maintaining optimal heart function, you can avoid the development of dyspnea (shortness of breath), a symptom that can complicate asthma and COPD.

Using Beta-Blockers Safely

The first generation beta-blockers were non-selective, meaning that they blocked both beta-1 and beta-2 receptors. Newer second-generation drugs are considered cardioselective as they have a greater affinity for beta-1 receptors. These include:

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

Generally speaking, cardioselective beta-blockers are considered safe for use in people with asthma or COPD.

Even so, people react differently to different drugs, so it is always wise to monitor for any unusual respiratory symptoms during the first four to six weeks of treatment. These include changes in breathing patterns or any increases in the severity or frequency of exacerbations.

Common Side Effects

Cardioselective beta-blockers may reduce the forced expiratory volume (FEV1) rate when first started. If you self-monitor your condition, be aware of this. In most cases, the FEV1 will normalize within a week or two once your body adapts to the drug.

Other common side effects of beta-blockers include:

  • Cold hands or feet
  • Diarrhea or constipation
  • Dizziness
  • Drowsiness
  • Dry mouth or eyes
  • Fatigue
  • Generalized weakness
  • Headaches
  • Upset stomach

Most of the side effects are manageable and tend to improve over time. Report any severe, persistent, or recurrent symptom to your doctor. In some cases, a dose reduction may be all that is needed to alleviate symptoms.

On the flip side, be aware that the selectivity of a beta-blocker may be reduced at higher doses. If a higher dose is prescribed, be especially vigilant when monitoring for side effects. If you're under the care of a separate cardiologist and pulmonologist, be sure that they are both on the same page with respect to your health and any drugs you may be taking.

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