Non‑selective beta‑blockers such as propranolol can precipitate bronchospasm and worsen airflow limitation in patients with asthma or COPD, making the combination potentially life‑threatening.
Non‑selective β‑blockers are contraindicated in obstructive airway disease.
Even cardio‑selective β‑blockers can cause bronchospasm at higher doses.
Monitor peak expiratory flow (PEF) or spirometry after any β‑blocker initiation.
Educate patients to report new wheezing or shortness of breath promptly.
Propranolol blocks both β1 and β2 adrenergic receptors. β2‑receptor antagonism in the bronchial smooth muscle removes the bronchodilatory effect of endogenous catecholamines and inhaled β2‑agonists, leading to increased airway resistance, bronchoconstriction, and reduced response to rescue bronchodilators.
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