I am a 55 yr old male diagnosed with cardiomyopathy with an EF of 30. Problem is I am also an Asthmatic . The ideal treatment would be a beta blocker like Coreg but it may make my asthma worse. They want to put in a pacemaker /defib unit in. Any advice from someone facing similar scenario?
Hello. Without having your complete medical history and physical exam is impossible to give you a specific answer. Generally speaking the publications which support the increased risk of asthma exacerbation with beta blockers (BB) are based in old studies done mainly with propranolol. New evidence based data suggest that newer BB like carvedilol can be used safely in asthmatic patients but with precautions. Usually the exacerbation is seen with the first doses, so close clinical follow up is recommended after starting the treatment. This is especially important when carvedilol is used as it is the less cardio selective of the new generation of BB. If intolerance to carvedilol has been proven d/t bronchoconstriction, it can be replaced with the more selective forms like metoprolol, bisoprolol and if out of the US, nebivolol. In the other hand, there are numerous publications that support the use of BB in heart failure patients in terms of increasing survival and quality of life, so BB should not be avoided in a patient only because of asthma. Good luck.
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