Influence of β2-adrenoceptor 16 genotype on propranolol-induced bronchoconstriction in patients with persistent asthma

Anderson, William J.; Short, Philip; Manoharan, Arvind; Lipworth, Joseph; Lipworth, Brian J.

doi:10.1016/j.anai.2014.02.016

Cited by 4 publications

(2 citation statements)

References 6 publications

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“…Patients with persistent asthma who possess one or two copies of the arginine-16 β-2 receptor polymorphism are more prone to propranolol-induced bronchoconstriction, 27 while the same polymorphism confers a worse outcome on survival in patients who are receiving metoprolol post ACS. 28 However, in another post hoc analysis of patients with HF treated with metoprolol or carvedilol, no association with survival was seen for the arginine-16 polymorphism.…”

Section: Discussionmentioning

confidence: 99%

Underuse of β-blockers in heart failure and chronic obstructive pulmonary disease

Lipworth

Skinner²,

Devereux

et al. 2016

Heart

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ObjectiveAlthough β-blockers are an established therapy in heart failure (HF) guidelines, including for patients with chronic obstructive pulmonary disease (COPD), there remain concerns regarding bronchoconstriction even with cardioselective β-blockers. We wished to assess the real-life use of β-blockers for patients with HF and comorbid COPD.MethodsWe evaluated data from the Optimum Patient Care Research Database over a period of 1 year for co-prescribing of β-blockers with either an ACE inhibitor (ACEI) or angiotensin-2 receptor blocker (ARB) in patients with HF alone versus HF+COPD. Association with inhaler therapy was also evaluated.ResultsWe identified 89 861 patients with COPD, 24 237 with HF and 10 853 with both conditions. In patients with HF+COPD, the mean age was 79 years; 60% were male, and 27% had prior myocardial infarction. Of patients with HF+COPD, 22% were taking a β-blocker in conjunction with either ACEI/ARB (n=2416) compared with 41% of patients with HF only (n=10 002) (adjusted OR 0.54, 95% CI 0.51 to 0.58, p<0.001). Among HF+COPD patients taking inhaled corticosteroid (ICS) with long-acting β-agonist (LABA) and long-acting muscarinic antagonist, 27% of patients were taking an ACEI/ARB with β-blockers (n=778) versus 46% taking an ACEI/ARB without β-blockers (n=1316). Corresponding figures for those patients taking ICS/LABA were 20% (n=583) versus 48% (n=1367), respectively.ConclusionsThese data indicate a substantial unmet need for patients with COPD who should be prescribed β-blockers more often for concomitant HF.

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Section: Discussionmentioning

confidence: 99%

Underuse of β-blockers in heart failure and chronic obstructive pulmonary disease

Lipworth

Skinner²,

Devereux

et al. 2016

Heart

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“…It is also important to consider the potential impact of beta-2 receptor genotype on the risk-benefit equation for beta-blockers in COPD. It has been shown that asthmatic patients who possess one or two copies of the arginine-16 beta-2 receptor polymorphism are more prone to propranolol-induced bronchoconstriction in terms of FEV1 and airway resistance [73]. While the arginine-16 polymorphism conferred a worse outcome on survival in patients receiving metoprolol after an acute coronary syndrome [74], it was not associated with survival in heart failure patients treated with metoprolol or carvedilol [75].…”

Section: Choice Of Beta-blocker and Effects On Pulmonary Functionmentioning

confidence: 99%

Beta-blockers in COPD: time for reappraisal

et al. 2016

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The combined effects on the heart of smoking and hypoxaemia may contribute to an increased cardiovascular burden in chronic obstructive pulmonary disease (COPD). The use of beta-blockers in COPD has been proposed because of their known cardioprotective effects as well as reducing heart rate and improving systolic function. Despite the proven cardiac benefits of beta-blockers post-myocardial infarction and in heart failure they remain underused due to concerns regarding potential bronchoconstriction, even with cardioselective drugs. Initiating treatment with beta-blockers requires dose titration and monitoring over a period of weeks, and beta-blockers may be less well tolerated in older patients with COPD who have other comorbidities. Medium-term prospective placebo-controlled safety studies in COPD are warranted to reassure prescribers regarding the pulmonary and cardiac tolerability of beta-blockers as well as evaluating their potential interaction with concomitant inhaled long-acting bronchodilator therapy. Several retrospective observational studies have shown impressive reductions in mortality and exacerbations conferred by beta-blockers in COPD. However, this requires confirmation from long-term prospective placebo-controlled randomised controlled trials. The real challenge is to establish whether beta-blockers confer benefits on mortality and exacerbations in all patients with COPD, including those with silent cardiovascular disease where the situation is less clear.

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Year in review: basic science

Grayson

2015

Annals of Allergy, Asthma & Immunology

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Influence of β2-adrenoceptor 16 genotype on propranolol-induced bronchoconstriction in patients with persistent asthma

Cited by 4 publications

References 6 publications

Underuse of β-blockers in heart failure and chronic obstructive pulmonary disease

Underuse of β-blockers in heart failure and chronic obstructive pulmonary disease

Beta-blockers in COPD: time for reappraisal

Year in review: basic science

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