Adverse Event Data Suggest Selective β₁-blockers Pose Asthma Risk

The risks of asthma and asthma-like adverse events appear to be higher with selective β₁-blockers than with nonselective blockers and α- and β-blockers, according to study findings published online ahead of print in Respiratory Medicine.

“The findings suggested that individuals who use selective β₁-blockers are 15% more likely to report asthma-related events compared to those who do not use these drugs …” wrote corresponding author Mario Cazzola, MD, of the University of Rome Tor Vergata, Rome, Italy, and study coauthors. “Conversely, the ROR [reporting odds ratio] for nonselective β-blockers … suggested a slightly decreased risk of asthma-related events, with a 10% lower likelihood of reporting such events compared to those who were not using these medications.”

The study investigated the link between different classes of β-blockers, which are used to manage cardiovascular disease, and the risk of asthma and asthma-like adverse events in patients using disproportionality analysis and RORs.

Among a total 251 145 adverse events for β-blockers reported to the US Food and Drug Administration’s Adverse Event Reporting System, 4104 were classified as asthma-related events, according to the study.

An analysis that categorized β-blockers using the 3-class European Society of Cardiology system found that selective β₁-blockers had an ROR of 1.15 compared with 0.90 for nonselective β-blockers and 0.51 for α- and β-blockers.

For α- and β-blockers, “[t]he probability of patients using these drugs reporting asthma or asthma-like AEs was 49% lower than that of patients not using these drugs,” researchers reported.

An analysis that categorized β-blockers using the 7-class Vashistha and Kumar system found different risk profiles even within the same class. The lowest asthma risk signals were observed with dual α- and β-blockers (0.51 ROR), hydrophilic β-blockers (0.71 ROR), and lipophilic β-blockers (0.76 ROR). Regardless of intrinsic sympathomimetic activity, selective β₁-blockers had higher risks.

“Although the signals detected by disproportionality analysis are only candidate risks, the risk stratification resulting from our analysis highlights the need for cautious β-blocker selection in asthmatic patients or those predisposed to asthma,” researchers wrote.

Reference

Cazzola M, Ora J, Calzetta L, Rogliani P, Matera MG. β-blockers and asthma: surprising findings from the FAERS database. Respir Med. 2024;234:107849. doi:10.1016/j.rmed.2024.107849