Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Bhanu K Bhakhri

"The Journal of Clinical and Diagnostic Research (JCDR) has been in operation since almost a decade. It has contributed a huge number of peer reviewed articles, across a spectrum of medical disciplines, to the medical literature.
Its wide based indexing and open access publications attracts many authors as well as readers
For authors, the manuscripts can be uploaded online through an easily navigable portal, on other hand, reviewers appreciate the systematic handling of all manuscripts. The way JCDR has emerged as an effective medium for publishing wide array of observations in Indian context, I wish the editorial team success in their endeavour"



Dr Bhanu K Bhakhri
Faculty, Pediatric Medicine
Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
On Sep 2018




Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dematolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011

Important Notice

Postgraduate Education
Year : 2011 | Month : April | Volume : 5 | Issue : 2 | Page : 414 - 417

β –Blockers in reactive airway disease

BHARTI CHOGTU, RAHUL MAGAZINE, K.L.BAIRY

Kasturba Medical College, Manipal University, Manipal, Karnataka- 576104

Correspondence Address :
Bharti Chogtu, MBBS, MD Pharmacology
Associate Professor, Pharmacology, Kasturba Medical College,
Manipal University, Manipal, Karnataka- 576104
Phone No. 9901728668
e-mail: bhartimagazine@gmail.com

Abstract

Beta-2- adrenergic agonists agonists are used in the treatment of reversible airway disease. β- blockers, due to their bronchoconstrictor effects, are supposed to be deleterious in such patients. In this review, we are putting forth some recent studies and meta analysis, which indicate that the chronic use of β- blockers in patients with reversible airway disease does not produce pulmonary impairment. Also, these drugs need not be withheld from patients with other diseases like hypertension, after weighing the risk: benefit ratio.

Keywords

β- blockers, COPD, Asthma

How to cite this article :

BHARTI CHOGTU, RAHUL MAGAZINE, K.L.BAIRY. β –BLOCKERS IN REACTIVE AIRWAY DISEASE. Journal of Clinical and Diagnostic Research [serial online] 2011 April [cited: 2018 Nov 17 ]; 5:414-417. Available from
http://www.jcdr.net/back_issues.asp?issn=0973-709x&year=2011&month=April&volume=5&issue=2&page=414-417&id=1258

INTRODUCTION
Paradoxical pharmacology is now well established for the management of certain clinical conditions like the use of β-blockers in congestive heart failure(1) and the use of methylphenidate or amphetamine to treat hyperactivity in children.(2) To understand the potential role of β blockers in the management of reactive airway diseases, we reviewed the current body of evidence that exists in the form of animal and human studies. Reactive airway disease is defined as bronchial asthma or chronic obstructive pulmonary disease (COPD) with a reversible obstructive component.(3) Asthma is characterized clinically by recurrent bouts of coughing, shortness of breath, chest tightness, and wheezing; physiologically by a widespread, reversible narrowing of the bronchial airways and by a marked increase in the bronchial responsiveness to inhaled stimuli; and pathologically by the lymphocytic, eosinophilic inflammation of the bronchial mucosa.(4) Chronic obstructive pulmonary disease (COPD) has been defined as a disease state which is characterized by an airflow limitation that is not fully reversible. It includes emphysema which is characterized by the destruction and the enlargement of the lung alveoli; chronic bronchitis which includes chronic cough and phlegm and by the small airways disease in which the small bronchioles are narrow.(5) In the airway smooth muscles, there is a balance between the sympathetic activity which produces bronchodilation and the parasympathetic activity which produces bronchoconstriction. Selective β 2-agonists are widely used for treatment of asthma and COPD due to their potent bronchodilatory action. However, the control of bronchial asthma worsens when β-agonists are inhaled regularly, as they confer no significant benefit on the lung function, but on the contrary, they may have a deleterious effect.(6) The bronchoprotective effect of the long-acting β-agonists i.e., their inhibition of exercise-induced bronchoconstriction rapidly wanes with regular use, a paradoxical effect that has not been fully explained. The β adrenoreceptor antagonists which are also known as β-blockers, are contraindicated in patients of bronchial asthma, because they can induce bronchoconstriction on acute dosing. However, chronic treatment has shown a decrease in the airway hyperresponsiveness. The hypothesis that the bronchospasm which is caused by the β-blockers is due to the competitive antagonism of the β2-adrenoreceptors (β2-AR) which in turn prevents bronchodilation by the endogenous catecholamines, is not consistent with the finding that significant levels of β2- receptor antagonism can be achieved without an accompanying decrease in the airway diameter.(7) There is also no evidence to support that mast cell degranulation occurs following the acute administration of β-blockers, as might be anticipated if the endogenous catecholamines were suppressing mast cell function.(8)

ANIMAL STUDIES:- The airway epithelium contains a large number of goblet cells which are filled with mucus, which protects the underlying tissue from the external environment(9). These cells are increased in numbers in asthma and contribute to the airflow obstruction(10).Acute treatment with the β blockers is accompanied by the worsening of the airway hyperresponsiveness (AHR) in sensitized and challenged mice, while chronic treatment for 28 days showed a protective effect on the airway responsiveness to methacholine.(11) The authors found that the chronic administration of carvedilol or nadolol increases the number of membrane associated β-ARs and that it is this change in the receptor number that results in the bronchoprotection against spasmogens.(11) A study which was conducted in the murine model of asthma revealed that β2- AR signaling was required for the full development of the three cardinal features of asthma, namely; mucosal metaplasia, airway hyperresponsiveness and inflammatory infiltration into the lungs.(9) In these experiments, genetic and pharmacological strategies to examine the effects of the β2-AR blockade were used. It was found that the chronic blockade of these receptors by an inverse agonist like nadolol, produced the attenuation of asthma –like the phenotype in the murine antigen derived model of mice. It has been suggested that two β blockers i.e. nadolol and ICI 118551 reduced the inflammatory cells in the bronchoalveolar lavage of antigen challenged mice. In addition, nadolol also reduced the levels of the cytokines, IL-13, IL-10, IL-5, and TGF-β1. Also, chronic treatment with the β blockers produced a marked, time dependent decrease in the goblet cell and mucin content of the airway epithelium. (10) However, β blockers have shown differential effects on different organs e.g. nebivolol significantly reduced heart rate without significantly increasing the pulmonary reactivity in guinea pigs.(12)

HUMAN STUDIES:- In human studies, it has been shown that chronic treatment with the β blockers does not cause pulmonary impairment. In a pilot study, a non selective β blocker like nadolol, which was administered to ten patients of asthma, resulted in more than a 10% fall in FEV1 after the first dose in four subjects. However, on using the escalating strategy for nine weeks, the drug was well tolerated and produced a dose dependent decrease in AHR to methacholine in most of the subjects.(13) The limitations of this study were its small sample size and the inclusion of patients with mild disease. Another meta-analysis of 20 homogeneous randomized controlled trials on the use of cardioselective β-blockers in patients with COPD, demonstrated that these agents, when given as a single dose for a long duration, produced no change in FEV1 or in the respiratory symptoms as compared to placebo. The findings remained unchanged in the subgroup analyses of the subjects with severe COPD.(14) Another study revealed that patients with poorly reversible COPD were resistant to the airway obstruction which was caused by the β- blockers. However, the β blockers which were used in this study had an intrinsic sympathomimetic activity and the parameters which were measured were wheezing and a fall in FEV1 to > 30%.(15) Comparison of a single oral dose of nebivolol and celiprolol revealed that there was a slight decrease in FEV1, but that none of the drugs impaired the lung functions in patients with mild asthma.(16) On the contrary, some studies recommend a cautious use of β- blockers in airway diseases. A study by van der Woude HJ etal, which was done to determine the effects of celiprolol, propranolol and metoprolol on FEV1 and airway hyperresponsiveness, found that propranolol reduced FEV1 and the bronchodilating effect of formeterol. Metoprolol and propranolol increased the airway hyperresponsiveness, whereas celiprolol did not have any pulmonary effects.(17)Despite having a β2 sparing effect, celiprolol and metoprolol differed in their effects on AHR and the effect which was shown by metoprolol resembled that of propranolol. Thus, a property other than the β- receptor selectivity is involved in the increase in AHR in patients with COPD. Hence, it was demonstrated that the pulmonary effects of different β- blockers vary. Another study on 13 patients with COPD revealed that the pulmonary functions worsened with the orally administered non selective β- blocker, propranolol. The authors recommend that the serial measurement of the pulmonary functions should be done as a therapeutic guide to detect progressive deterioration(18) It has been found in a study, that 28% of the 270 patients who were discharged from a university hospital after an acute exacerbation of COPD, were suffering from hypertension.(19)β- blockers are valuable agents in the treatment of hypertension. They must be used with extreme care in patients with asthma.(20) A pilot study comparing nebivolol and nifedipine in patients with hypertension showed that both agents produced a similar and significant reduction in the blood pressure. FEV1 was decreased non-significantly in the nifedipine group and slightly in the nebivolol group. However, the day to day airway obstruction control was similar in both the groups. (21)Even the American College of Chest Physicians recommends that the application of a new class of α-β blockers with an β- blocking activity in hypertensive patients with compromised pulmonary function, is warranted. (22)In patients with concomitant COPD and heart failure, Recio-Iglesias J etal found that the β-blocker use was determined by LVEF without any relationship to the severity of COPD.(23) Camsari and his colleagues did not come across any side effect which could be attributed to metoprolol in 50 patients with coronary heart disease and COPD.(24)

Discussion

The hypothesis regarding the role of the chronic use of β-blockers in bronchial asthma started as a theoretical concept, but later,animal studies showed some positive results. This was followed by human studies, some of which have shown encouraging results. Some authors are of the opinion that prescribing selective β blockers, particularly those with an intrinsic sympathomimetic activity, in patients with stable mild to moderate asthma, appears to be safe(Table/Fig 1).(25) The intrinsic sympathomimetic activity in part will stimulate the β-receptors as well.(26) Beta blockers do not impair the health status in patients with coexisting COPD. In view of the life preserving effects in patients with cardiovascular disease, it has been suggested that β blockers can in most circumstances, be judiciously administered in patients with COPD.(27). The diminished use of β blockers in patients with COPD is of concern, considering that many patients with COPD ultimately die of cardiovascular causes and in particular, ischaemic heart disease. (28) There is little evidence that serious harm occurs secondarily on the use of cardioselective agents, when given carefully under specialist supervision and at low doses. (29) A recent study suggested that the use of β blockers may reduce mortality as well as the risk of exacerbations of COPD, in patients with COPD with concurrent cardiovascular disease. (30)Cardioselective β-blockers reduced long term mortality in patients with COPD, who underwent major vascular surgery. (31) Intensified dosing regimens appeared to be superior to low doses in terms of their impact on a 30-day mortality.31 In conclusion, it appears safe to prescribe cardioselective betablockers in mild to moderate reversible airway diseases under medical supervision. Keeping in mind the benefits of beta blockers in conditions like heart failure and hypertension, these agents should not be withheld from such patients. Current evidence suggests that giving beta-blockers to patients with coronary artery disease and chronic obstructive pulmonary disease (COPD) or asthma lowers the 1-year mortality rate to a degree which is similar to that in patients without COPD or asthma, without worsening the respiratory function(32). However, long term trials are needed to establish their safe use in these comorbidities.

Key Message

β- blockers are no longer absolute contraindications in patients with reactive airway disease. Various studies and metaanalysis now show that this group of drugs can be safely used and they have more so shown benefits in the subgroup of the population with concomitant cardiovascular and airway diseases.

References

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. Salpeter SR, Ormiston TM, Salpeter EE. Cardioselective β-blockers in patients with reactive airway disease: A meta-analysis. Ann Intern Med. 2002; 137: 715- 25.
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. Boushey HA. Drugs used in Asthma. Katzung BG, MastersSB, Trevor AJ editors. In: Basic and Clinical Pharmacology, 11th ed. New Delhi: The Mc Graw Hill Companies; 2009: p339-56.
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. Reilly JJ, Silverman EK, Shapiro SD. Chronic Obstructive Pulmonary Disease. Fauci AS, Braunwald E, Kasper DL, Hauser SL, Longo DL, Jameson JL, Loscalzo J editors. In : Harrison’s Principles of Internal Medicine, 17th ed.Mc Graw Hill USA; 2008: p1635-43.
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. Boskabady MH, Snashall PD. Bronchial responsiveness to β adrenergic stimulation and enhanced β-blockade in asthma. Respirology 2000; 5: 111-18
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. Van Schoor J, Joos JF, Pauwels RA. Indirect brochial hyperresponsiveness in asthma: mechanisms, pharmacology and implications for clinical research. Eur Respir J 2000; 16: 514-33
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. Nguyen LP, Lin R, ParraS, Omoluabi O, Hanania NA, Tuvim MJ, Knoll BJ etal. β2- adrenoreceptor signaling is required for the development of an asthma phenotype in a murine model. PNAS 2009; 106: 2435-40.
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. Nguyen LP, Omoluabi O, Parra S, Frieske JM, Clement C, Ammar- Aouchiche Z etal. Chronic exposure to beta-blockers attenuates inflammation and mucin content in murine asthma model. Am J Respir Cell Mol Biol 2008: 38: 256-62.
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. Callaerts- Vegh Z, Evans KL, Dudekula N, Cuba D, Knoll BJ, Callaerts PF etal. Effects of acute and chronic administration of β-adrenoceptor ligands on airway function in murine model of asthma. Proc Natl Acad Sci USA 2004; 101: 4948-53.
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. De Clerck F, Van Gorp L, Loots W and Janssen PA.Differential effects of nebivolol, atenolol and propranolol on heart rate and on bronchoconstrictor responses to histamine in the guinea-pig. Arch Int Pharmacodyn Ther 1989; 298:230–36
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. Hanania NA, Singh S, Eli-Wali R, Flashner M, Franklin AE, Garner WJ etal. The safety and effects of the β blocker, nadolol, in mild asthma: an open –label pilot study. Pulm Pharmacol Ther 2008; 21: 134-41.
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. Salpeter SR, Ormiston TM, Salpeter EE. Cardioselective β-blockers for chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews 2005, Issue 4. Art. No.: CD003566. DOI:10.1002/14651858.CD003566.pub2.
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. Clauge HW, Ahmad D, Carruthers SC. Influence of cardioselectivity and respiratory disease on pulmonary responsiveness to β blockers. Eur J Clin Pharmacol 1984; 27: 517-23.
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