title: Respiratory effect of beta-blocker eye drops in asthma: population-based study and meta-analysis of clinical trials.
abstract: To measure the prevalence of beta-blocker eye drop prescribing and respiratory effect of ocular beta-blocker administration in people with asthma.
  
  
  
  We measured the prevalence of ocular beta-blocker prescribing in people with asthma and ocular hypertension, and performed a nested case-control study (NCCS) measuring risk of moderate exacerbations (rescue steroids in primary care) and severe exacerbations (asthma hospitalization) using linked data from the UK Clinical Practice Research Datalink. We then performed a systematic review and meta-analysis of clinical trials evaluating changes in lung function following ocular beta-blocker administration in people with asthma.
  
  
  
  From 2000 to 2012, the prevalence of non-selective and selective beta-blocker eye drop prescribing in people with asthma and ocular hypertension fell from 23.0% to 13.4% and from 10.5% to 0.9% respectively. In the NCCS, the relative incidence (IRR) of moderate exacerbations increased significantly with acute non-selective beta-blocker eye drop exposure (IRR 4.83, 95% CI 1.56-14.94) but not with chronic exposure. In the meta-analysis, acute non-selective beta-blocker eye drop exposure caused significant mean falls in FEV1 of -10.9% (95% CI -14.9 to -6.9), and falls in FEV1 of ≥20% affecting one in three. Corresponding values for selective beta-blockers in people sensitive to ocular non-selective beta-blockers was -6.3% (95% CI -11.7 to -0.8), and a non-significant increase in falls in FEV1 of ≥20%.
  
  
  
  Non-selective beta-blocker eye drops significantly affect lung function and increase asthma morbidity but are still frequently prescribed to people with asthma and ocular hypertension despite safer agents being available.
authors.affiliation: Quality, Safety & Informatics Group, Division of Population Health Sciences, School of Medicine, University of Dundee, UK.
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Morales
authors.affiliation: NHS Tayside Medicines Governance Unit, Dundee, UK.
authors.forename: Tobias
authors.initials: T
authors.lastname: Dreischulte
authors.affiliation: Scottish Centre for Respiratory Research, School of Medicine, University of Dundee, UK.
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Lipworth
authors.affiliation: Dundee Epidemiology and Biostatistics Unit, Division of Population Health Sciences, School of Medicine, University of Dundee, UK.
authors.forename: Peter T
authors.initials: PT
authors.lastname: Donnan
authors.affiliation: School of Medicine, University of Central Lancashire, UK.
authors.forename: Cathy
authors.initials: C
authors.lastname: Jackson
authors.affiliation: Quality, Safety & Informatics Group, Division of Population Health Sciences, School of Medicine, University of Dundee, UK.
authors.forename: Bruce
authors.initials: B
authors.lastname: Guthrie
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D001249:Asthma / Q000139:chemically induced*; D004363:Drug Utilization / Q000706:statistics & numerical data / Q000639:trends; D005541:Forced Expiratory Volume / Q000187:drug effects; D006801:Humans; D008168:Lung / Q000187:drug effects*; D009798:Ocular Hypertension / Q000188:drug therapy; D009883:Ophthalmic Solutions / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D000319:Adrenergic beta-Antagonists; D009883:Ophthalmic Solutions
keywords: asthma; beta-blocker; drug safety; glaucoma; meta-analysis