Topical beta blockers in asthmatic patients-is it safe?

To investigate the use of topical ocular anti-glaucoma medications by glaucomatous patients with obstructive pulmonary disease and their effect on related hospitalizations and emergency room visits.

We followed the electronic medical records of all the members in a district of the largest health maintenance organization in Israel (the "central district" of Clalit Health Services) older than 20 years (317,469 members); 6597 of them were on chronic topical anti-glaucoma treatment of which 693 (10.5%) suffered from obstructive pulmonary disease (OPD).

In a historical cohort study, we documented all anti-glaucoma prescriptions filled in the district between January 1, 2001, and December 31, 2003, and all emergency room (ER) visits and hospitalizations in internal medicine, geriatric, or pulmonology departments.

The rate of hospitalization and emergency room visits during treatment with each anti-glaucoma medication.

Five hundred forty-four glaucomatous OPD patients (78.5%) were treated with topical beta-blockers, but only 169 (31.1%) of them received a cardio-selective beta-blocker (betaxolol). Patients treated with betaxolol each received more prescriptions per year than patients treated with timolol (p < 0.0001). Patients on topical betaxolol or timolol had 23.1 and 20.7 hospitalization days as well as 7.3 and 6.1 emergency room visits per 100 treatments per year, respectively, compared to a mean of 10 hospitalization days (p < 0.0001) and 5.0 ER visits for patients on non-beta-blocker anti-glaucoma medications.

A majority of glaucomatous patients with obstructive pulmonary disease were treated with topical beta-blockers, mostly non-cardioselective (timolol). Those patients were more prone to be hospitalized or visit the emergency room while on the medication.