Study Suggests an Increase in Monitoring Needed For Patients With Asthma, COPD

Some guidelines recommend avoiding use of non‐selective (NS) β‐blockers in patients with asthma or COPD. Patients who have asthma or COPD, however, often have numerous comorbidities, and see a number of different types of prescribers.

Dutch researchers report that in the Netherlands, on average, each community pharmacy sees approximately 10 patients with respiratory disease who have prescriptions for NS β‐blockers monthly. In a study published in the Journal of Evaluation in Clinical Practice, researchers set out to identify the reasons why prescribers and pharmacists continue to prescribe NS β‐blockers despite the guidelines recommending against it.

These researchers involved 53 community pharmacists, and identified patients who were using inhaled medications for COPD or asthma and NS β‐blockers (N = 827). Pharmacists selected 3 prescribers, and conducted short interviews to determine if they were aware of the problem and why they might have chosen to prescribe NS β‐blockers.

From among the 827 patients, pharmacists interviewed 153 prescribers. These prescribers came from all walks of practice, including general medicine, ophthalmology, cardiology, and other specialties. They found that 107 prescribers were aware of the drug-disease interaction, and 46 prescribers did not realize that concurrent use of NS β‐blockers in these disease conditions was contraindicated.

Forty prescribers considered the contraindication irrelevant.

In a subset of 299 patients, the researchers were able to pull records associated with the first dispensing of the NS β‐blocker. The drug most likely to be prescribed was ophthalmic atenolol, with 39.8% of patients receiving this preparation. When interviewed, ophthalmologists often indicated that they had never seen atenolol-induced respiratory exacerbations. The study authors indicate that it would be unlikely for ophthalmologists to actually see the exacerbations, as patients would most likely seek care from a general practitioner or a respiratory specialist.

In second and third place were oral propranolol and oral carvedilol, accounting for 30.8% and 15.1%, respectively

The pharmacy's dispensing system generated a warning alert for 154 of these patients.

The researchers indicate that prescribers tend to be unaware of or ignore this potential drug-disease interaction. They call on healthcare systems to increase education in this area, and pharmacists specifically to increase their vigilance and notify prescribers when they see this potential interaction.

Reference

Kuipers E, Wensing M, De Smet PAGM, Teichert M. Considerations of prescribers and pharmacists for the use of non-selective β-blockers in asthma and COPD patients: An explorative study. J Eval Clin Pract. 2018;24(2):396-402.