Pulmonary safety of ophthalmic beta-blockers: a nationwide registry-based cohort study.
PURPOSE
Ophthalmic beta-blockers, used in the treatment of increased intraocular pressure, are known to cause pulmonary adverse effects. Few, if any, studies have quantified the extent of the problem in a real-life population. In this nationwide study, we assess the pulmonary safety of patients initiating treatment with ophthalmic beta-blockers.


METHODS
Using the Danish Nationwide Registries from 1995 to 2012, we identified all individuals aged 20-90 years who initiated monotherapy with an intraocular pressure-lowering drug, with or without concomitant obstructive pulmonary disease. Risks of (i) switching to another drug and (ii) new onset of obstructive pulmonary disease during a 90-day follow-up were examined by cumulative risk and logistic regression models adjusted for available covariates.


RESULTS
The cohort consisted of 97 463 individuals. Odds ratios for drug switch in individuals without concomitant obstructive pulmonary disease (n = 86 568) were as follows: 1.47 for beta-blockers (95% confidence interval (CI): 1.35-1.61; p < 0.001), 2.68 for parasympathomimetics (95% CI: 2.32-3.10; p < 0.001) and 4.80 for alfa-2-agonists (95% CI: 4.17-5.53; p < 0.001). Odds ratios in individuals with concomitant obstructive pulmonary disease (n = 10 895) were as follows: 2.61 for parasympathomimetics (95% CI: 1.83-3.72; p < 0.001), 2.96 for beta-blockers (95% CI: 2.31-3.78; p < 0.001) and 3.54 for alfa-2-agonists (95% CI: 2.56-4.88; p < 0.001). There was no significant association between treatment class and new onset of obstructive pulmonary disease (p = 0.30).


CONCLUSION
Ophthalmic beta-blockers were associated with an increased risk of drug switch. However, the absolute risk was very small. No increased risk of new onset of obstructive pulmonary disease was found. Our data suggest that more patients might be eligible for ophthalmic beta-blockers.
['Kristensen|Mathias L|ML|http://orcid.org/0000-0003-4606-0386', 'Simonsen|Jan H|JH|', 'Torp-Pedersen|Christian|C|', 'Vorum|Henrik|H|', 'Aasbjerg|Kristian|K|']
D000319:Adrenergic beta-Antagonists D000328:Adult D000368:Aged D000369:Aged, 80 and over D000959:Antihypertensive Agents D003718:Denmark D057915:Drug Substitution D005260:Female D005901:Glaucoma D006801:Humans D007429:Intraocular Pressure D008168:Lung D008171:Lung Diseases D008297:Male D008875:Middle Aged D029424:Pulmonary Disease, Chronic Obstructive D012042:Registries D012189:Retrospective Studies D055815:Young Adult
beta-blockers intraocular pressure adverse effects obstructive pulmonary disease glaucoma timolol