Beta-Blockers Use for Asthma and COPD

List of medications, uses, and risks in those with these conditions

Beta-blockers are a type of medication used in the treatment of heart disease and hypertension (high blood pressure). 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).

If you have asthma or COPD, you might have an increased risk of experiencing harmful side effects from beta-blockers, such as shortness of breath or an exacerbation of other respiratory symptoms. What's tricky is that these drugs are often beneficial if you have both heart disease and pulmonary (lung) disease, which is common.

This article goes over what you need to know about taking beta-blockers if you have asthma or COPD. It also includes a list of different beta-blockers and what they do.

Man about to swallow a pill

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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. They are also used to treat certain arrhythmias, and, in some instances, 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.

How Beta-Blockers Help Asthma and COPD

Patients with lung disease sometimes benefit from taking beta-blockers. If you have asthma or COPD, taking beta-blockers might be beneficial because:

  • 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.

Some research has shown that taking beta-blockers might be linked to fewer COPD exacerbations and even reduce the chances of dying from the condition (COPD mortality).

The benefits must be carefully weighed against notable risks of using beta-blockers if you have asthma or COPD.

Pulmonary Side Effects

There can be side effects of taking beta-blockers if you have lung disease because 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 a lung condition like asthma or COPD.

Respiratory side effects of beta-blockers can include:

Studies have also shown that beta-blockers do not always cause asthma exacerbations. It depends on the type of beta-blocker, the dose, and how long a person takes them.

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

Types and List of Beta-Blockers

Beta-blockers are either selective or non-selective. The difference is in which receptors each one acts on. Beta-blockers can act on beta-1 receptors, beta-2 receptors, or both.

In general, beta-1 receptors are more prevalent in the heart, while beta-2 receptors are more prevalent in the lungs.

Non-Selective (First Generation)

First-generation beta-blockers are non-selective. They block both beta-1 and beta-2 receptors.

Here is a list of first-generation beta-blockers:

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

Selective (Second Generation)

Second-generation beta-blockers are newer medications and are generally preferred for people with COPD or asthma. They are considered cardioselective, meaning they have a greater affinity for beta-1 receptors.

Here is a list of second-generation, cardioselective beta-blockers:

  • Brevibloc (esmolol)
  • Tenormin (atenolol)
  • Toprol XL (metoprolol succinate)
  • Zebeta (bisoprolol fumarate)
  • Bystolic (nebivolol)

Risks Associated With Beta-Blockers

People often worry taking a beta-blocker will make asthma or COPD worse. 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, or more subtle respiratory effects that can be measured with diagnostic tests. Non-selective beta-blockers may lead to asthma or COPD exacerbations.

If you have asthma or COPD, your provider might suggest selective beta-blockers instead of non-selective beta-blockers. However, cardioselective beta-blockers have risks and side effects as well.

For example, they 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.

General Risks of Use

There are risks of taking beta-blockers for anyone, not just people with asthma or COPD. Some of the general risks of beta-blockers include:

  • Circulation problems that may cause you to have cold hands and feet
  • Weight changes and digestive symptoms
  • Low blood pressure that causes you to feel dizzy or lightheaded
  • Sexual side effects like erectile dysfunction
  • Trouble breathing
  • High blood sugar
  • Trouble sleeping or nightmares
  • Feeling depressed
  • Heart problems
  • Liver problems
  • Kidney problems

Taking Beta-Blockers With Asthma or COPD Medication

It's possible that the medications you use to treat asthma, COPD, or other conditions might not be safe to mix with beta-blockers.

For example, research has shown that beta-blockers can make asthma inhalers not work as well. If a person's asthma treatment doesn't work as it should, they may have more frequent and severe attacks.

Other medications that can change how beta-blockers work include the following:

  • Drugs used to treat blood pressure
  • Some antidepressants
  • Allergy medications
  • Diabetes medications
  • Over-the-counter medications that have caffeine in them
  • Over-the-counter cold symptom products
  • Antihistamines
  • Antacids with aluminum in them

Beta-Blocker Use Contraindications

Some people cannot safely take beta-blockers. Your provider will talk to you about the risks and benefits of using them based on your situation.

Taking beta-blockers can sometimes make asthma or COPD worse. There have been reports of beta-blockers triggering asthma attacks. People with severe cases may not be able to take beta-blockers because the medication could make it harder to control their symptoms.

There are also other health problems that can make it unsafe for you to use beta-blockers, such as:

  • Being older (over the age of 60)
  • Being pregnant, breastfeeding, or wanting to conceive
  • Having a slow heartbeat
  • Having diabetes or blood sugar problems
  • Having thyroid conditions
  • Having problems with your kidneys or liver
  • Having allergies to food colorings and dyes or having seasonal allergies

A Word From Verywell

There are risks and benefits to taking beta-blockers if you have asthma or COPD. Cardioselective beta-blockers might be a better option if you have pulmonary disease. You may need a prescription for a non-cardioselective beta-blocker if you have asthma or COPD. Keep in mind that people react differently to different drugs.

If you have asthma or COPD and take beta-blockers, watch for any new respiratory symptoms, such as changes in your breathing pattern or increases in the severity or frequency of your asthma or COPD exacerbations, and tell your provider right away if they happen.

Frequently Asked Questions

  • What does "cardioselective" mean?

    A beta-blocker that acts on beta-1 receptors, which are common in the heart, is considered to be selective or cardioselective.

  • Which beta-blockers are not cardioselective?

    Inderal (propranolol), Trandate (labetalol), Corgard (nadolol), and Coreg (carvedilol) are not cardioselective.

  • Do beta-blockers always make asthma and COPD worse?

    The research on beta-blockers, asthma, and COPD is a little mixed. It really depends on how severe the conditions are, which beta-blockers are being used, and other medications a person might be taking.

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Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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By Craig O. Weber, MD
Craig O. Weber, MD, is a board-certified occupational specialist who has practiced for over 36 years.