SYSTEMATIC REVIEW article
Front. Physiol.
Sec. Respiratory Physiology and Pathophysiology
Volume 16 - 2025 | doi: 10.3389/fphys.2025.1582740
An updated insight into the effect of β-adrenergic receptor antagonists (β-blockers) on respiratory function in asthma patients: a systematic review and meta-analysis
Provisionally accepted
Monika Marko
Rafał Pawliczak*- Medical University of Lodz, Łódź, Poland
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Background: This study aimed to provide an updated assessment of the changes in respiratory function after β-adrenergic receptor antagonists (β-blockers) administration in asthma patients. The main assumption of the study was to use new methodological and statistical approaches not previously applied in this field in systematic reviews and meta-analysis. Methods: To select studies PubMed/Medline, Embase, ClinicalTrials.gov, and Cochrane Library were searched. Additionally, Google Scholar was searched for grey literature. A systematic review and meta-analysis for forced expiratory volume in one second (FEV1) and peak expiratory flow rate (PEFR) in asthma patients after administration of cardio-selective and non-selective β-blockers compared to placebo or baseline was performed. We also assessed FEV1 after topical β-blockers application compared to baseline. Results: An independent subgroup analysis demonstrated significantly higher FEV1 in the placebo group (standardized mean difference [SMD] = - 0.74, 95% confidence interval (CI): - 1.15, - 0.34, P = 0.0003) compared to non-selective β-blockers. The test for subgroup differences indicates that there is statistically significant subgroup effect among cardio-selective and non-selective β-blockers (P = 0.03, I2 = 80%). We also showed a statistically significant fall in FEV1 (SMD = - 0.70, 95% CI: [- 1.56, - 0.03], P = 0.04) after topical β-blockers application. Conclusion: Patients with asthma may tolerate cardio-selective β-blockers better than non-selective β-blockers. FEV1 value depends on the type of these β-blockers used. Cardio-selective β-blockers may be cautiously considered in patients with asthma only when strong cardiovascular indications exist (such as heart failure with reduced ejection fraction or post-myocardial infarction) and with appropriate monitoring. At the same time, less risky therapeutic options should be chosen instead of topical β-blockers.
Keywords: Asthma, beta-blockers, cardio-selective, FEV1, non-selective, PEFR, Safety
Received: 24 Feb 2025; Accepted: 13 Jun 2025.
Copyright: © 2025 Marko and Pawliczak. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Rafał Pawliczak, Medical University of Lodz, Łódź, Poland
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