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Original article
Prescribing of β-adrenoceptor antagonists in asthma: an observational study
  1. Daniel R Morales1,
  2. Bruce Guthrie2,
  3. Brian J Lipworth3,
  4. Peter T Donnan4,
  5. Cathy Jackson1
  1. 1School of Medicine, University of St Andrews, Fife, UK
  2. 2Quality & Safety Improvement Research Group, Division of Clinical & Population Sciences & Education, University of Dundee, Dundee, UK
  3. 3Asthma & Allergy Research Group, University of Dundee, Dundee, UK
  4. 4Dundee Epidemiology & Biostatistics Unit, Division of Clinical & Population Science & Education, University of Dundee, Dundee, UK
  1. Correspondence to Professor Cathy Jackson, School of Medicine, Medical & Biological Sciences Building, North Haugh, University of St Andrews, St Andrews, Fife KY16 9TF, UK; c.jackson{at}


Background β-Antagonists have recently been proposed for the treatment of chronic asthma; however, concerns regarding risk of acute bronchoconstriction in clinical trials remain.

Objective To determine the frequency of oral β-blocker prescribing in patients with asthma and associations with severe asthma exacerbations requiring oral steroids in patients with active asthma defined by prior asthma-related medication use.

Methods Patients with asthma registered on 31 March 2007 and all asthma-related medications from the preceding 2 years were identified from anonymised clinical data from one-third of Scottish general practices. The main outcome measure was the relative incidence of active asthma patients receiving oral steroids following a new oral β-antagonist prescription.

Results Of the 53 994 adult patients identified with asthma 1527 (2.8%; 95% CI 2.69% to 2.97%) patients were prescribed an oral β-antagonist of which 441 (28.9%, 95% CI 26.7% to 31.2%) had active asthma and received a new β-blocker prescription. The average number of patients prescribed rescue steroids at baseline in 367 patients with sufficient follow-up was 3.4 (0.9%) patients every 2 weeks. Rescue steroids were prescribed to 3 (0.8%) patients in the first 2 weeks and to 3 (0.8%) patients in the second 2 weeks following the new oral β-antagonist (incidence rate ratio (IRR) 0.87, 95% CI 0.25 to 2.99 and IRR 0.89, 95% CI 0.26 to 2.97, respectively). No significant difference was found following stratification for β-antagonist selectivity.

Conclusion These results suggest that prescribing new oral β-blockers for the purpose of investigating potentially beneficial effects of chronic treatment would not lead to large increases in patients treated with oral steroids acutely in general practice.

  • Asthma
  • asthma epidemiology
  • asthma in primary care
  • asthma pharmacology
  • drug reactions
  • COPD mechanisms
  • asthma mechanisms
  • COPD exacerbations
  • cough/mechanisms/pharmacology

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  • Funding The study was funded by NHS Quality Improvement Scotland. NHS Education for Scotland provided funding for the role of DRM. Neither organisation had any influence on the analysis or publication of the work.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.