Beta Blockers in Interstitial Lung Disease

Introduction to Beta Blocker Safety

The European Society of Cardiology states that beta blockers are not contraindicated in COPD, including severe emphysema, when cardioselective agents are used 1
Beta blockers are only relatively contraindicated in asthma due to bronchial hyperreactivity, but not in other pulmonary conditions without active bronchospasm 1

Beta blockers should be avoided in patients with active bronchospasm or reversible airflow obstruction, such as active asthma component or severe bronchospastic disease 2, 3, 1
Beta blockers are contraindicated in severe COPD with significant reversibility in airway obstruction on bronchodilator testing 1

The American Heart Association recommends using cardioselective beta-1 selective agents, such as bisoprolol, metoprolol succinate, or nebivolol, in patients with ILD 2, 3, 1
Non-selective beta blockers like carvedilol should be avoided in patients with pulmonary concerns, as they can cause bronchoconstriction 4

The European Society of Cardiology suggests starting with low doses of beta blockers, such as bisoprolol 1.25 mg daily, metoprolol succinate 12.5-25 mg daily, or nebivolol 1.25 mg daily, and titrating gradually every 1-2 weeks if well tolerated 1
Patients should be monitored for any new respiratory symptoms, such as wheezing, increased dyspnea, or change in sputum, and ensured not to be in acute exacerbation of their ILD before initiating beta blockers 1

The American College of Cardiology recommends prescribing beta blockers at discharge for all AMI patients unless specific contraindications exist, and ILD is not listed among the denominator exceptions 2, 3
Beta blockers remain Class I indicated for all patients with heart failure and reduced ejection fraction, regardless of ILD presence, with a proven mortality benefit of 30% reduction 5, 6