Breathing Problems In Older Adults Using Beta-Blocking Eye Drops For Glaucoma

Beta-blockers, a family of drugs frequently prescribed for high-blood pressure, are also very useful (as eye drops) in controlling elevated pressure in the eye (glaucoma). The beta-blockers used for this purpose include betaxolol (BETOPTIC), carteolol (OCUPRESS), levobetaxolol (BETAXON), levobunolol (BETAGAN), metipranolol (OPIPRANOLOL), and timolol (TIMOPTIC).

Because beta-blocking drugs, including the topical products, affect both the heart and the lungs these drugs should not be used in patients with bronchial asthma or a history of that disease; severe chronic obstructive pulmonary disease (COPD), and certain types of heart problems such as slow heart rate (sinus bradycardia), heart block or heart failure.

These drugs, when used for glaucoma, can also cause breathing problems in patients without an existing or prior history of asthma or COPD. We wrote about this in the August 1995 issue of Worst Pills, Best Pills News, based on research published in the medical journal The Lancet on June 25, 1995. This study found that timolol caused a decrease in breathing function and ability to exercise in older adults, even in those without a previous history of asthma or breathing problems.

New research, with a similar result as above, was published in the December 14, 2002 British Medical Journal. The study looked at two groups of patients from a large database in the United Kingdom with no previous diagnosis of breathing problems.

The first group examined were patients with no previous history of breathing difficulties who in the 12 months following treatment with a topical beta-blocker for glaucoma had been prescribed, for the first time, a drug used to treat reversible airways obstruction (asthma). These drugs included inhaled bronchodilators such as albuterol (PROVENTIL, VENTOLIN), inhaled steroids — budesonide (PULMICORT) and triamciolone (AZMACORT) are examples, theophylline (SLO-BID, SLO-PHYLLIN), and ipratropium (ATROVENT). The second patient group had the same characteristics as the first, and also had a new diagnosis of asthma or COPD added to their medical record.

Both groups were compared to a control group of a similar age who were not using a topical beta-blocker.

At 12 months after being prescribed a topical beta-blocker, 1.9 percent more patients in the first group were receiving a new drug to treat a reversible airways disorder such as asthma. This translates to one patient in 55 being treated with a topical beta-blocker developing an airways disorder that requires treatment with a new drug.

In the second group of patients, 3.3 percent more were treated with a new drug for reversible airways disorder such as asthma and were diagnosed with asthma or COPD than the control patients. This computes to 1 patient in 30 treated with a topical beta-blocker for one year receiving a new drug for breathing problems and being diagnosed with asthma or COPD.

What You Can Do

If you have pre-existing breathing or certain heart conditions, the topical beta-blockers should not be used to treat glaucoma. (See pages 623-624 of Worst Pills, Best Pills, 1999 edition, for discussion of glaucoma.)

If you have not previously had a breathing problem and have been prescribed a topical beta-blocker for glaucoma and experience breathing difficulties, contact your physician immediately.