A Cochrane review [Abstract] 1 included 29 studies with subjects with mild to moderate airways obstruction; 9 studies (n=240) on single-dose treatment and 10 studies on continued treatment (n=141). Compared to placebo, single doses of cardioselective beta-blockers as a group were associated with a reduction in FEV1 (MD -7.46%, 95% CI -9.32 to -5.59%), but with an increase in FEV1 after beta2-agonist was given (MD 4.63%, 95% CI 2.47 to 6.78%). There was no increase in respiratory symptoms seen in any of the 19 studies (RD 0.01, 95% CI -0.02 to 0.03).Treatment lasting 3 to 28 days produced no change in FEV1 (MD -0.42% change from baseline, 95% CI -3.74 to 2.91), symptoms or inhaler use, whilst maintaining an 8.74% (95% CI 1.96 to 15.52) response to beta2-agonist.
With continued treatment there was no significant difference in FEV1 response for beta1-blockers without ISA compared to those with ISA: -3.22% (95% CI -7.79 to 1.36) compared to 2.72% (95% CI -2.12 to 7.57). Those without ISA produced a 12.0% increase in FEV1 after beta2-agonist administration compared to placebo (95% CI 4.12 to 19.87) while beta1-blockers with ISA produced no change compared to placebo (MD -0.60%; 95% CI -13.93 to 12.73). These results were obtained in a small number of studies with few patients. The difference was not significant.There was no significant change in FEV1 treatment effect for those patients with chronic obstructive pulmonary disease (COPD): single doses (MD -5.28%, 95% CI -10.03 to -0.54); continued treatment (MD 1.07%, 95% CI -3.30 to 5.44).
Comment: The quality of evidence is downgraded by imprecise results (few patients and outcome events).
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