This is an excellent question, as the mainstay of therapy for acute exacerbations of asthma relies on bronchodilation produced by beta-1 agonists such as salbutamol. Thus, classical teaching has suggested that the use of beta-blockers is contraindicated in patients with asthma. There is, however, a reasonable body of literature suggesting that beta-blockers can, with care, be used in patients with asthma when they’re indicated for conditions such as hypertension.

When deciding to use a beta-blocker in a patient with asthma, there are several things to consider. First, the patient’s asthma must be under good control. Patients with unstable asthma are not good candidates for therapy with a beta-blocker. Second, the indication should be clear: beta-blockers should only be used for conditions in which they have been shown to have proven benefit, for example in reducing mortality. In these circumstances, it would still be prudent to use a cardioselective beta-blocker such as atenolol or metoprolol. A Cochrane review suggested that in these circumstances beta-blocker therapy doesn’t produce short-term adverse respiratory effects. An issue to remember is that cardioselectivity in beta-blockers is relative — at higher doses, cardioselectivity is lost, and therefore beta-blockers are best used in the setting of mild to moderately severe disease.

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