β-Blockers and Asthma: Surprising findings from the FAERS database

Area of Science:

• Pharmacology and Therapeutics
• Cardiovascular Disease Management
• Respiratory Medicine

Background:

• Beta-blockers are crucial for managing cardiovascular diseases but can cause respiratory issues, especially non-selective agents.
• The safety of beta-blockers in patients with asthma remains a significant clinical concern and subject to ongoing debate.

Purpose of the Study:

• To investigate the association between different classes of beta-blockers and the risk of asthma or asthma-like adverse events.
• To evaluate beta-blocker safety profiles in asthmatic patients using real-world data.

Main Methods:

• Utilized the Food and Drug Administration's Adverse Event Reporting System (FAERS) database.
• Employed disproportionality analysis, calculating the reporting odds ratio (ROR) to assess asthma risk signals.
• Classified beta-blockers using both the European Society of Cardiology and Vashistha and Kumar systems.

Main Results:

• A total of 4104 asthma-related adverse events were identified among 251,145 reported beta-blocker events.
• Selective β1-blockers exhibited a higher asthma risk signal (ROR: 1.15) than non-selective beta-blockers (ROR: 0.90).
• Dual α- and β-blockers demonstrated the lowest asthma risk (ROR: 0.51), with variations observed across different classifications and properties (e.g., lipophilicity).

Conclusions:

• The study identified significant variability in asthma-related risks among different beta-blocker classes, necessitating cautious selection in patients with asthma.
• Specific beta-blockers like esmolol, metoprolol, nebivolol, and nadolol may be preferable, while betaxolol, bisoprolol, timolol, and propranolol warrant avoidance.
• Findings underscore the importance of risk stratification for beta-blocker use in vulnerable patient populations, despite FAERS data limitations.