Beta Blocker Therapy in Mild to Moderate Asthmatics (ANDA1)

Evaluation of Any Steroid Sparing Effect of Beta Blocker Therapy on Airway Hyper-responsiveness in Stable, Mild to Moderate Asthmatics

Current asthma medicines include inhalers. A common type of inhaler is called a 'beta-agonist' (e.g. salbutamol). They improve asthma symptoms by stimulating areas in the airway causing it to widen. Although these drugs are useful short term, long term use can make asthma worse in some people. 'Beta-blockers' are the complete opposite type of medication. Just now they are avoided in patients with asthma. Beta-blockers cause problems in asthmatics in the short term, including severe asthma attacks. The other mainstay of inhaler treatment for asthma is inhaled steroid or 'preventer' medication. These work by dampening down the inflammation in the lungs that occurs in asthma. New research has suggested that longer term use of beta-blockers can also reduce airway inflammation which may improve asthma control. This research was done in asthmatic patients who didn't need inhaled steroids to control their asthma. At the moment the investigators are studying to see if there is a benefit of beta-blocker use for asthma over and above asthmatics own usual doses of inhaled steroids. In this study, the investigators will be trying to find out if adding a beta blocker to a smaller dose of steroid inhaler has the same effect on asthma control as just using a higher dose of steroid inhaler by itself.

Change in: Resistance at 5Hz, Resistance at 20Hz, Reactance at 5Hz, Frequency of resonance, Area under reactance curve.

Change in: Forced expiratory volume in 1 second (FEV1); forced vital capacity (FVC); forced expriatory flow between 25-75% of vital capacity; FEV1/FVC ratio.

Abosolute change in heart rate at 6 weeks will be a secondary outcome. Participants will measure their own heart rate at home on a daily basis and compare this to a given cut-off value, below which they will be advised to contact a trial doctor.

Blood pressure will be monitored at each visit, or if patients develop symptoms that may be due to low blood pressure.

Change in symptom scores (Asthma control questionnaire and Asthma quality of life questionnaire) at 6 weeks

Inclusion Criteria: Stable mild to moderate asthma Histamine PC20 </= 8mg/ml Receiving inhaled corticosteroid 0-1000ug daily (BDP equivalent dose) FEV1 > 60% predicted Diurnal variability < 30% Reliever use </= 8puffs/day ECG demonstrating sinus rhythm Exclusion Criteria: Uncontrolled symptoms of asthma Systolic BP<110mmHg Heart rate<60bpm Pregnancy or lactation Heart block Heart rate limiting medications currently prescribed Asthma exacerbation within 6 months of study commencement

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