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.
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 language | English |
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Article number | 18 |
Number of pages | 9 |
Journal | BMC Medicine |
Volume | 15 |
DOIs | |
Publication status | Published - 27 Jan 2017 |
Keywords
- Asthma
- Cardiovascular disease
- Beta-blocker
- Drug safety
- Pharmacovigilance
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Dive into the research topics of 'Respiratory effect of beta-blockers in people with asthma and cardiovascular disease: population-based nested case control study'. Together they form a unique fingerprint.Profiles
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Donnan, Peter
- Population Health and Genomics - Professor (Teaching and Research) of Epidemiology and Biostatistics
Person: Academic
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Lipworth, Brian
- Respiratory Medicine and Gastroenterology - Clinical Professor (Teaching and Research) of Allergy and Respiratory Medicine
Person: Academic
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Morales, Daniel
- Population Health and Genomics - Wellcome Trust Clinical Research Fellow
Person: Research