Beta-blockers are a type of medication used in the treatment of heart disease and hypertension (high blood pressure). However, your medical team may be cautious about prescribing beta-blockers for you if you have a respiratory condition such as asthma or chronic obstructive pulmonary disease (COPD). If you have asthma or COPD, you might have an increased risk of experiencing harmful side effects from beta-blockers, such as shortness of breath or an exacerbation of other respiratory symptoms.
What's tricky about this is that it is common to have both heart disease and pulmonary (lung) disease—and beta-blockers are often beneficial even when you have both conditions. In some cases, your healthcare provider may prescribe a beta-blocker and ask you to watch out for and report any side effects that you experience. In others, newer drug options may be more appropriate.
This article will go over what you need to know about taking beta-blockers if you have asthma or COPD. It also includes a list of different beta-blockers that can help you decide which beta-blocker might be best if you have asthma or COPD.
What Beta-Blockers Do
Beta-blockers, also known as beta-adrenergic receptor blockers, decrease heart rate and blood pressure. This is helpful if you have hypertension and/or heart failure. Beta-blockers are often used to reduce the risk of a heart attack in people who have heart disease. They are also used to treat certain arrhythmias, and, in some instances, for preventing migraines.
These prescription drugs block the effects of epinephrine, the hormone responsible for increasing heart rate and raising blood pressure. By binding to molecules on the surface of the heart and blood vessels—known as beta-1 receptors—beta-blockers decrease the effects of epinephrine. As a result, the heart rate is slowed, the force of heart contractions is reduced, and blood pressure is decreased.
Use With Respiratory Disease
Patients with lung disease sometimes benefit from taking beta-blockers. If you have asthma or COPD, taking beta-blockers might be beneficial because:
- They can help maintain optimal blood pressure and heart function, helping you avoid dyspnea (shortness of breath).
- COPD is associated with an increased risk of heart failure, which beta-blockers can help treat.
- Heart disease is a leading cause of death among people who have pulmonary disease, and these drugs can reduce that risk.
The benefits must be carefully weighed against notable risks of using beta-blockers if you have asthma or COPD.
Pulmonary Side Effects
There can be side effects of taking beta-blockers if you have lung disease because beta receptors are also found in lung tissue. When epinephrine binds to beta receptors in the lungs, the airways relax (open). That is why you might use an EpiPen to treat a respiratory emergency.
Beta-blockers cause the airways in the lungs to contract (narrow), making it difficult to breathe. This isn't usually a problem unless you already have blockage or narrowing in your airways from a lung condition like asthma or COPD.
Respiratory side effects of beta-blockers can include:
If you experience any of these issues, it is important that you discuss your symptoms with your healthcare provider. Sometimes, a dose reduction can alleviate the medication side effects. Get immediate medical attention if you experience severe symptoms.
Types of Beta-Blockers
Beta-blockers are either selective or non-selective. The difference is in which receptors each one acts on. Beta-blockers can act on beta-1 receptors, beta-2 receptors, or both.
In general, beta-1 receptors are more prevalent in the heart, while beta-2 receptors are more prevalent in the lungs.
Non-Selective (First Generation)
First-generation beta-blockers are non-selective. They block both beta-1 and beta-2 receptors.
Here is a list of first-generation beta-blockers:
- Inderal (propranolol)
- Trandate (labetalol)
- Corgard (nadolol)
- Coreg (carvedilol)
Selective (Second Generation)
Second-generation beta-blockers are newer medications. They are considered selective—more specifically, they are cardioselective. Being cardioselective means the beta-blocker has a greater affinity for beta-1 receptors.
Here is a list of second-generation beta-blockers:
- Brevibloc (esmolol)
- Tenorman (atenolol)
- Toprol XL (metoprolol succinate)
- Zebeta (bisoprolol fumarate)
- Bystolic (nebivolol)
Beta-Blockers and Pulmonary Disease
Cardioselective beta-blockers are considered safer if you have a pulmonary disease, such as asthma or COPD.
People often worry taking a beta-blocker will make asthma or COPD worse. While selective beta-blockers are not as likely to cause pulmonary side effects as non-selective beta-blockers, they can cause pulmonary side effects, especially at high doses. When taking these drugs, you may experience shortness of breath, wheezing, or more subtle respiratory effects that can be measured with diagnostic tests. Non-selective beta-blockers may lead to asthma or COPD exacerbations.
If you have asthma or COPD, your provider might suggest selective beta-blockers instead of non-selective beta-blockers. However, cardioselective beta-blockers have risks and side effects as well. For example, they may reduce forced expiratory volume (FEV1). This is more common when you first start taking them. FEV1 is a measure of the volume of air that you can expire with maximal effort in one second. In most cases, the FEV1 will normalize within a week or two once your body adapts to the drug.
A Word From Verywell
There are risks and benefits to taking beta-blockers if you have asthma or COPD. Cardioselective beta-blockers might be a better option if you have pulmonary disease. You may need a prescription for a non-cardioselective beta-blocker if you have asthma or COPD. Keep in mind that people react differently to different drugs. If you have asthma or COPD and take beta-blockers, watch for any new respiratory symptoms, such as changes in your breathing pattern or increases in the severity or frequency of your asthma or COPD exacerbations, and tell your provider right away if they happen.