title: Avoiding unsuspected respiratory side-effects of topical timolol with cardioselective or sympathomimetic agents.
abstract: Topical timolol given for the treatment or chronic simple glaucoma may cause unrecognised bronchospasm among elderly people. We recruited 80 patients aged over 60 years, who were without a history of airways disease and already used timolol, into a randomised crossover study comparing the effects on spirometry and exercise tolerance of changing to betaxolol or dipivefrine therapy. Results showed an increase of 13% and 8% in mean peak flow rate and forced expiratory volume in 1 s (FEV1), respectively, when using betaxolol; and of 14% and 11% when using dipivefrine. There was also improved exercise tolerance with both agents. More than a quarter of the patients showed at least a 15% improvement in FEV1 when changed from timolol. Analysis of enrolment symptoms and response to nebulised salbutamol failed to produce a method of identifying these patients. Timolol may impair respiratory function and exercise tolerance of elderly patients even if they have no history of reversible airways disease.
authors.affiliation: Department of Medicine for the Elderly, St James's University Hospital, Leeds, UK.
authors.forename: P
authors.initials: P
authors.lastname: Diggory
authors.forename: A
authors.initials: A
authors.lastname: Cassels-Brown
authors.forename: A
authors.initials: A
authors.lastname: Vail
authors.forename: L M
authors.initials: LM
authors.lastname: Abbey
authors.forename: J S
authors.initials: JS
authors.lastname: Hillman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015784:Betaxolol / Q000494:pharmacology*; D018592:Cross-Over Studies; D004837:Epinephrine / Q000031:analogs & derivatives* / Q000494:pharmacology; D017079:Exercise Tolerance / Q000187:drug effects*; D005260:Female; D005541:Forced Expiratory Volume / Q000187:drug effects; D005902:Glaucoma, Open-Angle / Q000188:drug therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D010366:Peak Expiratory Flow Rate / Q000187:drug effects; D013147:Spirometry; D013999:Timolol / Q000009:adverse effects / Q000494:pharmacology*
chemical_list: D013999:Timolol; C015173:dipivefrin; D015784:Betaxolol; D004837:Epinephrine