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Title: Elderly Risk Airways Obstruction From Beta Blockers For Glaucoma

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BMJ 2002; 325: 1396-7.
12/13/2002 01:46:03 PM
By Harvey McConnell

There is an excess risk of airway obstruction among elderly men and women who are prescribed beta blockers to control their glaucoma or ocular hypertension, British researchers declare. Their findings raise an immediate public health issue as some 500,000 elderly men and women in Britain are being treated for glaucoma or ocular hypertension, say Dr. James Kirwan and colleagues at the Department of International Eye Health, Institute of Ophthalmology, London, England. Ophthalmologists, family doctors, and pharmacists need to know airway obstruction is possible among patients prescribed topical beta blockers. It is known that beta blockers can exacerbate bronchospasm in asthma and chronic obstructive pulmonary disease. Dr Kirwan and colleagues used data over a five year period from 2,645 patients who had used ophthalmic topical beta blockers for the first time, and during the first year of treatment were also given a drug for the treatment of reversible airways obstruction. They were compared with 9,094 matched controls. Among 3, 358 patients in both groups, including patients with previous airway obstruction begun on a topical beta blocker during the study period, 148 (4.4 percent ) had used drugs for airways obstruction within the previous year. The researchers calculated that 55 patients would need to be treated to cause one case of airways obstruction during that time period. The researchers add that if they allow in their calculations for a certain rate of missed diagnosis or misdiagnosis, they may have underestimated the true risk. They also suggest that many frail elderly patients may be better off left untreated than risk airway obstruction. They conclude that for family doctors "a repeat prescription that includes topical beta blockers and drugs for asthma should automatically sound an alarm."

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