title: Topical beta blockers in asthmatic patients-is it safe?
abstract: OBJECTIVE
  To investigate the use of topical ocular anti-glaucoma medications by glaucomatous patients with obstructive pulmonary disease and their effect on related hospitalizations and emergency room visits.
  
  
  METHODS
  We followed the electronic medical records of all the members in a district of the largest health maintenance organization in Israel (the "central district" of Clalit Health Services) older than 20 years (317,469 members); 6597 of them were on chronic topical anti-glaucoma treatment of which 693 (10.5%) suffered from obstructive pulmonary disease (OPD).
  
  
  METHODS
  In a historical cohort study, we documented all anti-glaucoma prescriptions filled in the district between January 1, 2001, and December 31, 2003, and all emergency room (ER) visits and hospitalizations in internal medicine, geriatric, or pulmonology departments.
  
  
  METHODS
  The rate of hospitalization and emergency room visits during treatment with each anti-glaucoma medication.
  
  
  RESULTS
  Five hundred forty-four glaucomatous OPD patients (78.5%) were treated with topical beta-blockers, but only 169 (31.1%) of them received a cardio-selective beta-blocker (betaxolol). Patients treated with betaxolol each received more prescriptions per year than patients treated with timolol (p < 0.0001). Patients on topical betaxolol or timolol had 23.1 and 20.7 hospitalization days as well as 7.3 and 6.1 emergency room visits per 100 treatments per year, respectively, compared to a mean of 10 hospitalization days (p < 0.0001) and 5.0 ER visits for patients on non-beta-blocker anti-glaucoma medications.
  
  
  CONCLUSIONS
  A majority of glaucomatous patients with obstructive pulmonary disease were treated with topical beta-blockers, mostly non-cardioselective (timolol). Those patients were more prone to be hospitalized or visit the emergency room while on the medication.
authors.affiliation: Department of Ophthalmology, Barzilai Medical Center, Ashkelon, Israel. igor@drkaiserman.com
authors.forename: Igor
authors.initials: I
authors.lastname: Kaiserman
authors.forename: Anna
authors.initials: A
authors.lastname: Fendyur
authors.forename: Shlomo
authors.initials: S
authors.lastname: Vinker
mesh_terms: D000287:Administration, Topical; D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage / Q000009:adverse effects*; D000368:Aged; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000009:adverse effects*; D001249:Asthma / Q000139:chemically induced* / Q000503:physiopathology; D002908:Chronic Disease; D015331:Cohort Studies; D000075202:Contraindications; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D057286:Electronic Health Records; D004638:Emergency Treatment / Q000706:statistics & numerical data*; D005260:Female; D005902:Glaucoma, Open-Angle / Q000188:drug therapy*; D006279:Health Maintenance Organizations / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D029424:Pulmonary Disease, Chronic Obstructive / Q000139:chemically induced* / Q000503:physiopathology; D018570:Risk Assessment
chemical_list: D000319:Adrenergic beta-Antagonists; D000959:Antihypertensive Agents