Description
Propranolol, a non-selective beta-blocker, directly antagonises the bronchodilatory and cardiovascular effects of albuterol, potentially causing severe bronchospasm in patients with asthma or COPD.
Mechanism
Albuterol acts as a beta-2 adrenergic agonist to cause bronchodilation; propranolol blocks both beta-1 and beta-2 receptors, reversing bronchodilation, potentially precipitating life-threatening bronchoconstriction.
Clinical Significance
Well-documented antagonism; non-selective beta-blockers are contraindicated in reactive airway disease; acute bronchospasm fatalities have been reported.
Management
Avoid non-selective beta-blockers in asthma/COPD patients; use cardioselective beta-blockers (e.g., metoprolol, bisoprolol) at the lowest effective dose when beta-blockade is necessary.