Avoiding unsuspected respiratory side-effects of topical timolol with cardioselective or sympathomimetic agents

Lancet. 1995 Jun 24;345(8965):1604-6. doi: 10.1016/s0140-6736(95)90116-7.


Topical timolol given for the treatment or chronic simple glaucoma may cause unrecognised bronchospasm among elderly people. We recruited 80 patients aged over 60 years, who were without a history of airways disease and already used timolol, into a randomised crossover study comparing the effects on spirometry and exercise tolerance of changing to betaxolol or dipivefrine therapy. Results showed an increase of 13% and 8% in mean peak flow rate and forced expiratory volume in 1 s (FEV1), respectively, when using betaxolol; and of 14% and 11% when using dipivefrine. There was also improved exercise tolerance with both agents. More than a quarter of the patients showed at least a 15% improvement in FEV1 when changed from timolol. Analysis of enrolment symptoms and response to nebulised salbutamol failed to produce a method of identifying these patients. Timolol may impair respiratory function and exercise tolerance of elderly patients even if they have no history of reversible airways disease.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Betaxolol / pharmacology*
  • Cross-Over Studies
  • Epinephrine / analogs & derivatives*
  • Epinephrine / pharmacology
  • Exercise Tolerance / drug effects*
  • Female
  • Forced Expiratory Volume / drug effects
  • Glaucoma, Open-Angle / drug therapy
  • Humans
  • Male
  • Middle Aged
  • Peak Expiratory Flow Rate / drug effects
  • Spirometry*
  • Timolol / adverse effects
  • Timolol / pharmacology*


  • Timolol
  • dipivefrin
  • Betaxolol
  • Epinephrine