Beta-adrenergic-blocking agents in bronchospastic diseases: a therapeutic dilemma

Cardioselective beta-blockers should be administered starting with a low dosage under direct medical observation. Bronchodilators should be readily available or may be coadministered. Because of several advantages, agents such as metoprolol, atenolol, and, in some cases, esmolol should be the first agents considered. In contrast to noncardioselective agents, if bronchospasm occurs, the effect of cardioselective agents is believed to be easier to reverse. Clinicians should avoid noncardioselective beta-blockers in asthmatics, even in small doses, such as those administered as eye drops. For asthmatic patients who are intolerant to noncardioselective beta-blockers, switching to a cardioselective beta-blocker might be a safe alternative. The significance of beta2-blockade usually varies with the patient's ventilatory condition, with more serious consequences being anticipated in patients with more severe asthma.