Respiratory effect of beta-blockers in people with asthma and cardiovascular disease: population-based nested case control study

Daniel R. Morales (Lead / Corresponding author), Brian J. Lipworth, Peter T. Donnan, Cathy Jackson, Bruce Guthrie

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Abstract

Background: Cardiovascular disease (CVD) is a common comorbidity in people with asthma. However, safety concerns have caused heterogeneity in clinical guideline recommendations over the use of cardioselective beta-blockers in people with asthma and CVD, partly because risk in the general population has been poorly quantified. The aim of this study was to measure the risk of asthma exacerbations with beta-blockers prescribed to a general population with asthma and CVD.

Methods: Linked data from the UK Clinical Practice Research Datalink was used to perform nested case-control studies among people with asthma and CVD matched on age, gender and calendar time. Adjusted incidence rate ratios (IRR) were calculated for the association between oral beta-blocker use and moderate asthma exacerbations (rescue oral steroids) or severe asthma exacerbations (hospitalisation or death) using conditional logistic regression.

Results: The cohort consisted of 35502 people identified with active asthma and CVD, of which 14.1% and 1.2% were prescribed cardioselective and non-selective beta-blockers respectively during follow-up. Cardioselective beta-blocker use was not associated with a significantly increased risk of moderate or severe asthma exacerbations. Consistent results were obtained following sensitivity analyses and a self-controlled case series approach. In contrast, non-selective beta-blockers were associated with a significantly increased risk of moderate asthma exacerbations when initiated at low to moderate doses (IRR 5.16, 95%CI 1.83-14.54, p=0.002), and both moderate and severe exacerbations when prescribed chronically at high dose (IRR 2.68, 95%CI 1.08-6.64, p=0.033 and IRR 12.11, 95%CI 1.02-144.11, p=0.048 respectively).

Conclusions: Cardioselective beta-blockers prescribed to people with asthma and CVD were not associated with a significantly increased risk of moderate or severe asthma exacerbations and potentially could be used more widely when strongly indicated.
Original languageEnglish
Article number18
Number of pages9
JournalBMC Medicine
Volume15
DOIs
Publication statusPublished - 27 Jan 2017

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Case-Control Studies
Cardiovascular Diseases
Asthma
Population
Incidence
Comorbidity
Hospitalization
Logistic Models
Steroids
Guidelines
Safety

Keywords

  • Asthma
  • Cardiovascular disease
  • Beta-blocker
  • Drug safety
  • Pharmacovigilance

Cite this

@article{d1648ddc7c564e7eac3ca37524e2c274,
title = "Respiratory effect of beta-blockers in people with asthma and cardiovascular disease: population-based nested case control study",
abstract = "Background: Cardiovascular disease (CVD) is a common comorbidity in people with asthma. However, safety concerns have caused heterogeneity in clinical guideline recommendations over the use of cardioselective beta-blockers in people with asthma and CVD, partly because risk in the general population has been poorly quantified. The aim of this study was to measure the risk of asthma exacerbations with beta-blockers prescribed to a general population with asthma and CVD.Methods: Linked data from the UK Clinical Practice Research Datalink was used to perform nested case-control studies among people with asthma and CVD matched on age, gender and calendar time. Adjusted incidence rate ratios (IRR) were calculated for the association between oral beta-blocker use and moderate asthma exacerbations (rescue oral steroids) or severe asthma exacerbations (hospitalisation or death) using conditional logistic regression.Results: The cohort consisted of 35502 people identified with active asthma and CVD, of which 14.1{\%} and 1.2{\%} were prescribed cardioselective and non-selective beta-blockers respectively during follow-up. Cardioselective beta-blocker use was not associated with a significantly increased risk of moderate or severe asthma exacerbations. Consistent results were obtained following sensitivity analyses and a self-controlled case series approach. In contrast, non-selective beta-blockers were associated with a significantly increased risk of moderate asthma exacerbations when initiated at low to moderate doses (IRR 5.16, 95{\%}CI 1.83-14.54, p=0.002), and both moderate and severe exacerbations when prescribed chronically at high dose (IRR 2.68, 95{\%}CI 1.08-6.64, p=0.033 and IRR 12.11, 95{\%}CI 1.02-144.11, p=0.048 respectively).Conclusions: Cardioselective beta-blockers prescribed to people with asthma and CVD were not associated with a significantly increased risk of moderate or severe asthma exacerbations and potentially could be used more widely when strongly indicated.",
keywords = "Asthma, Cardiovascular disease, Beta-blocker, Drug safety, Pharmacovigilance",
author = "Morales, {Daniel R.} and Lipworth, {Brian J.} and Donnan, {Peter T.} and Cathy Jackson and Bruce Guthrie",
note = "The study was funded by a Scottish Government Chief Scientist Office Clinical Academic Fellowship which provided support for DM. No funding bodies had any role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.",
year = "2017",
month = "1",
day = "27",
doi = "10.1186/s12916-017-0781-0",
language = "English",
volume = "15",
journal = "BMC Medicine",
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TY - JOUR

T1 - Respiratory effect of beta-blockers in people with asthma and cardiovascular disease

T2 - population-based nested case control study

AU - Morales, Daniel R.

AU - Lipworth, Brian J.

AU - Donnan, Peter T.

AU - Jackson, Cathy

AU - Guthrie, Bruce

N1 - The study was funded by a Scottish Government Chief Scientist Office Clinical Academic Fellowship which provided support for DM. No funding bodies had any role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

PY - 2017/1/27

Y1 - 2017/1/27

N2 - Background: Cardiovascular disease (CVD) is a common comorbidity in people with asthma. However, safety concerns have caused heterogeneity in clinical guideline recommendations over the use of cardioselective beta-blockers in people with asthma and CVD, partly because risk in the general population has been poorly quantified. The aim of this study was to measure the risk of asthma exacerbations with beta-blockers prescribed to a general population with asthma and CVD.Methods: Linked data from the UK Clinical Practice Research Datalink was used to perform nested case-control studies among people with asthma and CVD matched on age, gender and calendar time. Adjusted incidence rate ratios (IRR) were calculated for the association between oral beta-blocker use and moderate asthma exacerbations (rescue oral steroids) or severe asthma exacerbations (hospitalisation or death) using conditional logistic regression.Results: The cohort consisted of 35502 people identified with active asthma and CVD, of which 14.1% and 1.2% were prescribed cardioselective and non-selective beta-blockers respectively during follow-up. Cardioselective beta-blocker use was not associated with a significantly increased risk of moderate or severe asthma exacerbations. Consistent results were obtained following sensitivity analyses and a self-controlled case series approach. In contrast, non-selective beta-blockers were associated with a significantly increased risk of moderate asthma exacerbations when initiated at low to moderate doses (IRR 5.16, 95%CI 1.83-14.54, p=0.002), and both moderate and severe exacerbations when prescribed chronically at high dose (IRR 2.68, 95%CI 1.08-6.64, p=0.033 and IRR 12.11, 95%CI 1.02-144.11, p=0.048 respectively).Conclusions: Cardioselective beta-blockers prescribed to people with asthma and CVD were not associated with a significantly increased risk of moderate or severe asthma exacerbations and potentially could be used more widely when strongly indicated.

AB - Background: Cardiovascular disease (CVD) is a common comorbidity in people with asthma. However, safety concerns have caused heterogeneity in clinical guideline recommendations over the use of cardioselective beta-blockers in people with asthma and CVD, partly because risk in the general population has been poorly quantified. The aim of this study was to measure the risk of asthma exacerbations with beta-blockers prescribed to a general population with asthma and CVD.Methods: Linked data from the UK Clinical Practice Research Datalink was used to perform nested case-control studies among people with asthma and CVD matched on age, gender and calendar time. Adjusted incidence rate ratios (IRR) were calculated for the association between oral beta-blocker use and moderate asthma exacerbations (rescue oral steroids) or severe asthma exacerbations (hospitalisation or death) using conditional logistic regression.Results: The cohort consisted of 35502 people identified with active asthma and CVD, of which 14.1% and 1.2% were prescribed cardioselective and non-selective beta-blockers respectively during follow-up. Cardioselective beta-blocker use was not associated with a significantly increased risk of moderate or severe asthma exacerbations. Consistent results were obtained following sensitivity analyses and a self-controlled case series approach. In contrast, non-selective beta-blockers were associated with a significantly increased risk of moderate asthma exacerbations when initiated at low to moderate doses (IRR 5.16, 95%CI 1.83-14.54, p=0.002), and both moderate and severe exacerbations when prescribed chronically at high dose (IRR 2.68, 95%CI 1.08-6.64, p=0.033 and IRR 12.11, 95%CI 1.02-144.11, p=0.048 respectively).Conclusions: Cardioselective beta-blockers prescribed to people with asthma and CVD were not associated with a significantly increased risk of moderate or severe asthma exacerbations and potentially could be used more widely when strongly indicated.

KW - Asthma

KW - Cardiovascular disease

KW - Beta-blocker

KW - Drug safety

KW - Pharmacovigilance

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U2 - 10.1186/s12916-017-0781-0

DO - 10.1186/s12916-017-0781-0

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C2 - 28126029

VL - 15

JO - BMC Medicine

JF - BMC Medicine

SN - 1741-7015

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