Cardioselective beta-blockers for reversible XXXX .

@entity1 @entity712 @entity101 @entity565 @entity8652 @entity3885 @entity1030 @entity2263 @entity453 @entity6587 @entity943
BACKGROUND: Beta-blocker therapy has mortality benefit in @entity1 with @entity101 , @entity712 and @entity453 , as well as during the perioperative period. These drugs have traditionally been considered contraindicated in @entity1 with reversible @entity1030 . OBJECTIVES: To assess the effect of cardioselective beta-blockers in @entity1 with @entity565 or @entity1030 . SEARCH STRATEGY: A search of EMBASE, MEDLINE and CINAHL was performed up to May 2002 using the terms: @entity565 *, @entity6587 *, respiratory sounds*, wheez*, @entity3885 * or obstructive @entity1030 *, and adrenergic antagonist*, sympatholytic* or adrenergic receptor block*. SELECTION CRITERIA: Randomized, blinded, placebo-controlled trials of single dose or continued treatment of the effects of cardioselective beta-blockers in @entity1 with reversible @entity1030 . DATA COLLECTION AND ANALYSIS: Two independent reviewers extracted data from the selected articles, reconciling differences by consensus. @entity8652 -blockers were divided into those with or without intrinsic sympathomimetic activity (ISA). Interventions were: administration of single or continued @entity8652 -blocker, and response to @entity2263 -agonist given after the study drug. MAIN RESULTS: Nineteen studies on single-dose treatment and 10 studies on continued treatment met the inclusion criteria. Single dose cardioselective beta-blocker produced a 7.46% (95% CI 5.59, 9.32) reduction in FEV1, but with a 4.63% (95% CI 2.47, 6.78) increase in FEV1 with @entity2263 -agonist, compared to placebo. Treatment lasting 3 - 28 days produced no change in FEV1 (-0.42%; 95% CI -3.74, 2.91), symptoms or inhaler use, whilst maintaining a 8.74% (95% CI 1.96, 15.52) response to @entity2263 -agonist. There was no significant change in FEV1 treatment effect for those @entity1 with @entity1030 : single doses -5.28% (95% CI -10.03, -0.54%), continued treatment 1.07% (CI -3.3, 5.44. With continued treatment there was no significant difference in FEV1 response for @entity8652 -blockers without ISA compared to those with IS: -3.22% (96%CI -7.79, 1.36) compared to 2.72% (95% CI -2.12, 7.59). Those without ISA produced a 12.0% increase in FEV1 after @entity2263 -agonist administration compared to placebo (95%CI 4.12,19.87) while @entity8652 -blockers with ISA produced no change compared to placebo (-0.60% [95%CI -13.93, 12.73). These results were obtained in a small number od studies of few @entity1 . The difference was not significant. REVIEWER'S CONCLUSIONS: Cardioselective beta-blockers given in mild - moderate reversible @entity1030 or @entity1030 , do not produce adverse respiratory effects in the short term. Given their demonstrated benefit in conditions such as @entity712 , @entity943 and @entity101 , these agents should not be withheld from such @entity1 , but long term safety (especially their impact during an acute exacerbation) still needs to be established.
