Oral propranolol in people with asthma and anxiety

Conference: 
SAPC ASM 2015 - Oxford - Evidence and innovation in primary care
Talk Code: 
EP2D.4

The problem Propranolol is a non-selective beta-blocker prescribed in the UK for the management of anxiety symptoms but may cause exacerbations in susceptible people with asthma.Objective: To measure propranolol prescribing trends in people with asthma and anxiety in UK primary care, and the association between oral exposure and asthma hospitalisation.

The approach

Data from the UK Clinical Practice Research Datalink was used to form a cohort of people with active asthma and anxiety in which the annual prevalence of propranolol prescribing was measured between 2000 and 2012. Active asthma was defined by the presence of Read codes and use of asthma medication. A nested case control study using up to 10 controls matched on age, gender and calendar time was used to calculate incidence rate ratios (IRR) for the association between propranolol exposure and asthma hospitalisation according to dose and duration, using conditional logistic regression.

Findings

The cohort included 20093 people with asthma and anxiety. A total of 470 asthma hospitalisations occurred during follow-up with an overall incidence of 7.1 per 1000 person-years. The annual period prevalence of propranolol prescribing was 2.0% at the end of the study period. The relative incidence of asthma hospitalisation increased within 30 days of any incident propranolol exposure (IRR 13.7 (95%CI 2.3-82.2)) and any high dose propranolol exposure (IRR 8.0 (95%CI 1.8-35.0)). The relative incidence of asthma hospitalisation was not significantly elevated with prevalent exposure.

Consequences

Despite safety concerns, propranolol is still prescribed to some people with asthma and anxiety. Propranolol exposure is associated with an increased risk of asthma hospitalisation in susceptible people which appears to vary by dose and duration of exposure. These findings support guidelines recommending the avoidance of propranolol for the management of anxiety symptoms in people with asthma.

Credits

  • DR Morales
  • BJ Lipworth
  • C Jackson
  • PT Donnan
  • B Guthrie