Rescue inhaler overuse linked to heart risks in asthma, COPD

Clinical takeaway: Patients with asthma or COPD who use short-acting bronchodilators (SABDs) frequently, particularly short-acting muscarinic antagonists (SAMAs) or fixed SABA+SAMA combinations, may warrant reassessment of disease control and closer cardiovascular risk evaluation. Collecting three or more SABA canisters annually was also associated with increased mortality and heart failure risk.

Overuse of short-acting beta-agonists (SABAs) is already recognized as a marker of poor asthma control, but less is known about the cardiovascular safety of SABDs more broadly, especially SAMA-containing rescue therapies. This study helps fill that gap by examining cardiovascular outcomes in a large, real-world population of patients with asthma and COPD.

In this Belgian nationwide cohort study, investigators followed more than 283,000 adults with asthma (n = 226,314) or COPD (n = 57,446) for an average of 3 years. Nearly half of patients used a SABD during the baseline year, and bronchodilator overuse (≥3 canisters/year) was observed in 17% of patients with asthma and 30% of those with COPD.

Compared with nonusers, patients using SAMA-containing therapies generally had the highest cardiovascular risks. In both asthma and COPD, SAMA use was associated with roughly 20% to 35% higher risks of heart failure, 18% to 41% higher risks of arrhythmia, and 23% to 73% higher mortality risks. Fixed-dose SABA+SAMA combinations were likewise linked to increased risks.

Among patients with asthma, use of these combination inhalers was associated with 15% to 46% higher MI risk, 15% to 31% higher ischemic stroke risk, 12% to 21% higher arrhythmia risk, 23% to 44% higher heart failure risk, and 28% to 70% higher mortality risk.

In COPD, heavy use of SABA+SAMA combinations (≥3 canisters/year) was associated with a 35% higher myocardial infarction risk, 16% higher arrhythmia risk, 27% higher heart failure risk, and 40% higher mortality risk.

By contrast, use of 1 to 2 SABA canisters per year was not associated with increased cardiovascular risk, while use of 3 or more canisters annually was associated with approximately 8% to 13% higher heart failure risk and 12% to 14% higher mortality risk in both disease populations.

“The high use of SABD (≥3 canisters/year) should be a trigger for healthcare providers to reassess disease management and closely monitor these patients,” the authors wrote.

Source: Van Vaerenbergh F, et al. (2026 Aug 25) ERJ Open Res. Cardiovascular Effects and Mortality of Short-Acting Bronchodilators in Asthma and COPD