TY - JOUR T1 - Effects of hydrocortisone on acute beta-blocker and histamine induced bronchoconstriction JF - European Respiratory Journal JO - Eur Respir J VL - 38 IS - Suppl 55 SP - p3970 AU - Philip Short AU - Peter Williamson AU - Lorna McKinlay AU - Brian Lipworth Y1 - 2011/09/01 UR - http://erj.ersjournals.com/content/38/Suppl_55/p3970.abstract N2 - Introduction and objectives: The benefits of chronic beta-blockade in asthma have recently been questioned, however concerns of bronchoconstriction persist with the greatest risk after first dose. We investigated the safety of acute exposure to propranolol in asthmatics, sequentially challenged with histamine to mimic an asthma exacerbation and evaluated the role of hydrocortisone in potentiating salbutamol reversibility.Methods: Persistent atopic asthmatics, ≤1000μg/day budesonide performed a randomised double-blind placebo-controlled crossover study. Following 10mg or 20mg of oral propranolol, patients received 400mg iv. hydrocortisone or placebo, followed by histamine challenge with nebulised salbutamol 5mg and ipratropium 500mcg recovery.Results: 13 patients completed per protocol. Hydrocortisone did not potentiate salbutamol recovery post-propranolol and histamine challenge. Beta-blocker induced bronchoconstriction was demonstrated by spiromery and IOS. For the placebo visit, FEV1% fell 4.7% 2hrs post-propranolol whilst R5% increased 31.3%. On both visits FEV1% and R5% returned to baseline after salbutamol post-histamine.Conclusion: Nebulised salbutamol produced a full recovery after propranolol and histamine induced bronchoconstriction, independent of hydrocortisone use. Our findings offer reassurance to those undertaking further evaluation of chronic beta-blockade as a potential treatment for asthma. ER -