Beta-1 selective adrenergic antagonist landiolol and esmolol can be safely used in patients with airway hyperreactivity

This study was undertaken to clarify the effects of esmolol and landiolol, beta-1 selective adrenergic antagonists, on hyperreactive airways in both ovalbumin-sensitized guinea pigs and asthmatic patients. In the animal study, asthma was induced by ovalbumin. After control acetylcholine responses for total pulmonary resistance (Raw) and dynamic lung compliance (Cdyn) were obtained, the animals received propranolol, esmolol, or landiolol, and the same protocol was again performed. Sixty inpatients with coronary risk factors and asthma were enrolled in the human study. Under propofol anesthesia, the patients received saline, esmolol, or landiolol. To assess intubation-induced bronchoconstriction, the presence of wheezing was determined. The dose-response curves of Raw and Cdyn to acetylcholine were significantly elevated and declined in the ovalbumin-sensitized model compared with those in the control group. Neither esmolol nor landiolol had any effect on the acetylcholine-induced response curve in these sensitized animals. However, propranolol significantly enhanced Raw and reduced Cdyn in this model. Tracheal intubation increased the incidence of wheezing in asthmatic patients. However, there was no significant difference in the incidence of wheezing among these groups. The ultra-short-acting beta-1 selective adrenergic antagonists esmolol and landiolol can be safely used perioperatively in patients with airway hyperreactivity.