title: The safety and effects of the beta-blocker, nadolol, in mild asthma: an open-label pilot study.
abstract: Beta-blockers are currently contraindicated in asthma because their acute administration may be associated with worsening bronchospasm. However, their effects and safety with their chronic administration are not well evaluated. The rationale for this pilot study was based on the paradigm shift that was observed with the use of beta-blockers in congestive heart failure, which once contraindicated because of their acute detrimental effects, have now been shown to reduce mortality with their chronic use. We hypothesized that certain beta-blockers may also be safe and useful in chronic asthma therapy. In this prospective, open-label, pilot study, we evaluated the safety and effects of escalating doses of the beta-blocker, nadolol, administered over 9 weeks to 10 subjects with mild asthma. Dose escalation was performed on a weekly basis based on pre-determined safety, lung function, asthma control and hemodynamic parameters. The primary objective was to evaluate safety and secondary objectives were to evaluate effects on airway hyperresponsiveness, and indices of respiratory function. The escalating administration of nadolol was well tolerated. In 8 out of the 10 subjects, 9 weeks of nadolol treatment produced a significant, dose-dependent increase in PC20 that reached 2.1 doubling doses at 40 mg (P<0.0042). However, there was also a dose-independent 5% reduction in mean FEV1 over the study period (P<0.01). We conclude that in most patients with mild asthma, the dose-escalating administration of the beta-blocker, nadolol, is well tolerated and may have beneficial effects on airway hyperresponsiveness. Our findings warrant further testing in future larger trials.
authors: Section of Pulmonary and Critical Care Medicine, Baylor College of Medicine, 1504 Taub Loop, Houston, TX 77030, USA. Hanania@bcm.edu <Hanania@bcm.edu>
authors: Nicola A
authors: NA
authors: Hanania
authors: Supria
authors: S
authors: Singh
authors: Rami
authors: R
authors: El-Wali
authors: Michael
authors: M
authors: Flashner
authors: Amie E
authors: AE
authors: Franklin
authors: William J
authors: WJ
authors: Garner
authors: Burton F
authors: BF
authors: Dickey
authors: Sergio
authors: S
authors: Parra
authors: Stephen
authors: S
authors: Ruoss
authors: Felix
authors: F
authors: Shardonofsky
authors: Brian J
authors: BJ
authors: O'Connor
authors: Clive
authors: C
authors: Page
authors: Richard A
authors: RA
authors: Bond
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage* / Q000009:adverse effects*; D000328:Adult; D001249:Asthma / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009248:Nadolol / Q000008:administration & dosage* / Q000009:adverse effects*; D010865:Pilot Projects; D011446:Prospective Studies; D012129:Respiratory Function Tests
chemical_list: D000319:Adrenergic beta-Antagonists; D009248:Nadolol
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