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Asthma

Asthma and beta blockers

08/11/2008

Question:

Hello,

First of all I am not really sure whether I am asthmatic. When I was in my early teens I used to have bronchitis when I caught the cold. I am now 46 years old and have never formally been on asthma medication. The only ones I have taken is Rhinorcort which really hypes me up and did nothing. I have sometimes I am allergic only to dust mites .

I suffer from shortness of breath all the time, but I have anxiety, TMJ , a deviated septum and a stiff neck and postural muscles. I have taken Ventolin in the past when I got the cold and couldn`t breathe too well.

A few years back I was given betaloc and after a week , I really had wheezing type of breathing.

Recently, my new doctor based on my childhood bronchitis story, told me I was asthmatic - once an asthmatic , always an asthmatic. He was reluctant to prescribe atenolol for my labile hypertension but then decided we should give it a try. He did a spirometry test, and my lung function was better than average. I was on atenolol for about a week but then I got the cold and I was scared to continue the atenolol in case I had an asthma attack .

So my question is am I really an asthmatic or do you think I have grown out of it. Are my shortness of breath symptoms more anxiety and muscular skeletal related as my lung function is good. Can I safely take atenolol during a cold. I constantly have do cope with this shortness of breath feeling that I wouldn`t really know what an asthma attack is before too late.

Thanks.

Answer:

Asthma is just one of many conditions that present with subjective shortness of breath. Some conditions can mimic asthma with wheezing and difficulty breathing. The pulmonary spirometry testing you had done is one of the best ways your physician can distinguish whether the shortness of breath you have is on the basis of asthma. A pulmonary function test while you are having symptoms is particularly helpful. Asthma is a condition that can wax and wane. It often is present life-long, though at different levels of activity.

Beta-blockers present difficulties for patients with asthma and allergies because they block part of the activity of epinephrine (adrenaline), which is a component of the body's natural response to allergic reactions. They also can block the effect of albuterol (Ventolin) and other drugs used to treat asthma. Generally one tries to avoid the use of beta-blockers in patients with asthma for this reason.

If one needs to use a beta-blocker in an asthmatic patient — which may be required for certain cardiac conditions such as arrhythmia — it is best to use an agent that is "cardio-selective". That means that the medication acts primarily on the heart and has less effect on airway performance. Atenolol is a "cardio-selective" beta-blocker that has been safely used in asthmatic patients. As usual one considers if a beta-blocker is the best option and if there is not another agent that can produce the desired effect.

You mention having a continuous shortness of breath, but that you had a normal pulmonary function test. Having a complete evaluation by a pulmonologist could help sort out how your symptoms are related to muscular or skeletal problems, anxiety, asthma or other conditions. An evaluation by an allergist could help both the pulmonologist and your family doctor identify triggers for shortness of breath.

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Response by:

Charity C Fox, MD Charity C Fox, MD
Clinical Associate Professor of Pulmonary, Allergy, Critical Care & Sleep
College of Medicine
The Ohio State University