title: Safety of therapeutic beta-blockade in patients with coexisting bronchospastic airway disease and coronary artery disease.
abstract: Atherosclerotic coronary artery disease and bronchospastic airway disease frequently coexist in older patients. There are substantial data suggesting reduced mortality with the use of beta-adrenergic blocking drugs in patients with symptomatic coronary artery disease, especially patients who have postmyocardial infarction and/or severe coronary artery disease associated with left ventricular dysfunction. Conversely, the use of beta-adrenergic blocking drugs (even selective beta(1)-adrenergic blocking drugs) has the potential of exacerbating bronchospasm. This prospective registry evaluates the safety of use of selective beta(1)-adrenergic blocking drugs in patients with symptomatic coronary artery disease and bronchospastic airway disease. A total of 835 consecutive patients with symptomatic coronary artery disease were prospectively evaluated for coexisting coronary and bronchospastic airway disease. Of these, 30 patients (mean age: 61 +/- 14 years) met the qualifying inclusion criteria. All these study patients except 1 (29/30 [96%]) reached therapeutic beta-blockade (resting heart rate <70 beats per minute). The 1 patient who discontinued use of beta-adrenergic blocking drugs as a result of lifestyle-limiting bronchospasm had no serious adverse outcome. No hospitalizations were required because of worsening bronchospasm. Ten percent of patients reported increased requirement of inhaled beta(2)-agonist use. The patients were followed for 15 +/- 9 months. One patient died of stroke at 22 weeks of follow-up. In conclusion, use of selective beta(1)-adrenergic blocking drugs at a therapeutic dose is safe (as long as careful clinical follow-up is available) and should be considered in all patients with coexisting symptomatic coronary artery disease and bronchospastic airway disease.
authors.affiliation: Section of Cardiology, Mount Sinai Hospital, North Chicago, IL 60608, USA. khos@sinai.org
authors.forename: Sandeep
authors.initials: S
authors.lastname: Khosla
authors.forename: Binu
authors.initials: B
authors.lastname: Kunjummen
authors.forename: Rizwan
authors.initials: R
authors.lastname: Khaleel
authors.forename: Rajnishpaul
authors.initials: R
authors.lastname: Kular
authors.forename: Marina
authors.initials: M
authors.lastname: Gladson
authors.forename: Mansour
authors.initials: M
authors.lastname: Razminia
authors.forename: Mayra
authors.initials: M
authors.lastname: Guerrero
authors.forename: Atul
authors.initials: A
authors.lastname: Trivedi
authors.forename: Vasundhara
authors.initials: V
authors.lastname: Vidyarthi
authors.forename: Ravi
authors.initials: R
authors.lastname: Manda
authors.forename: Monther
authors.initials: M
authors.lastname: Elbazour
authors.forename: Aziz
authors.initials: A
authors.lastname: Ahmed
authors.forename: David
authors.initials: D
authors.lastname: Lubell
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D001986:Bronchial Spasm / Q000139:chemically induced / Q000150:complications*; D003327:Coronary Disease / Q000150:complications* / Q000188:drug therapy; D023381:Endpoint Determination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
chemical_list: D000319:Adrenergic beta-Antagonists