Using ARBs in Asthmatic Patients

Safety Profile of ARBs in Asthma

• Angiotensin receptor blockers (ARBs) are safe and recommended for asthmatic patients, especially when ACE inhibitors cannot be tolerated due to cough or angioedema, as they do not inhibit kininase and are associated with a much lower incidence of cough and angioedema 1, 2
• ARBs produce hemodynamic, neurohormonal, and clinical effects consistent with renin-angiotensin system blockade without the respiratory side effects of ACE inhibitors 1, 3

Prescribing ARBs for Asthmatic Patients

• The American Heart Association recommends starting with low doses and titrating upward, with careful monitoring of blood pressure, renal function, and potassium levels within 1-2 weeks of initiation 1, 4
• Common ARBs with their initial and maximum doses are:

Precautions and Monitoring

• Use caution in patients with low systemic blood pressure, renal insufficiency, or elevated serum potassium (>5.0 mEq/L) 1, 2
• While ARBs are alternatives for patients with ACE inhibitor-induced angioedema, caution is advised as some patients have also developed angioedema with ARBs 4, 7

Special Considerations

• The American College of Cardiology recommends ARBs for patients with heart failure with reduced ejection fraction (HFrEF) who are ACE inhibitor intolerant 1, 4
• Avoid routine combined use of an ARB with an ACE inhibitor and aldosterone antagonist, as this combination increases risks of hypotension, renal dysfunction, and hyperkalemia 4