beta-adrenergic-blocking agents in bronchospastic diseases: A therapeutic dilemma

Cardioselective beta-blockers should be administered starting with a low do sage under direct medical observation. Bronchodilators should be readily av ailable or may be coadministered. Because of several advantages, agents suc h as metoprolol, atenolol, and, in some cases, esmolol should be the first agents considered. In contrast to noncardioselective agents, if bronchospas m occurs, the effect of cardioselective agents is believed to be easier to reverse. Clinicians should avoid noncardioselective beta-blockers in asthma tics, even in small doses, such as those administered as eye drops. For ast hmatic patients who are intolerant to noncardioselective beta-blockers, swi tching to a cardioselective beta-blocker might be a safe alternative. The s ignificance of beta(2)-blockade usually varies with the patient's ventilato ry condition, with more serious consequences being anticipated in patients with more severe asthma.