Short-Acting Bronchodilator Use Associated With Cardiovascular Events and Mortality

Increasing use of short-acting muscarinic antagonists (SAMAs) or fixed-dose short-acting beta-agonist (SABA)/SAMA combination inhalers was associated with higher cardiovascular and mortality risks among patients with asthma or chronic obstructive pulmonary disease (COPD), according to an observational study published in ERJ Open Research. Dispensing of at least 3 SABA canisters annually was also associated with higher risks of heart failure and death.

Investigators analyzed primary- and secondary-care data from 283,760 adults in Belgium, including 226,314 patients with asthma and 57,446 with COPD. Short-acting bronchodilator exposure during the baseline year was categorized as 0, 1 to 2, or at least 3 canisters. Analyses accounted for demographic factors, smoking and exacerbation history, nursing home residence, frailty, comorbidities, and medication use.

Compared with no SABA use, dispensing of at least 3 SABA canisters was associated with a 12% higher mortality risk among patients with asthma and a 14% higher risk among those with COPD. In contrast, dispensing of 1 to 2 SABA canisters was associated with lower mortality risks than no use. Dispensing of at least 3 SAMA canisters was associated with 73% and 36% higher mortality risks in the asthma and COPD groups, respectively.

Increasing SAMA and fixed-dose SABA/SAMA combination use was also associated with higher estimates for cardiovascular outcomes, including heart failure and arrhythmia. Among patients receiving SABA monotherapy, the cardiovascular findings were more limited. Sensitivity analyses produced higher cardiovascular and mortality estimates among patients without a prior history of cardiovascular disease.

The author described bronchodilator overuse as a potential indicator of inadequate disease control that may warrant review of disease management, treatment adherence, and inhaler technique. Because the study was observational, the findings establish associations but not causation. The investigators plan to examine whether greater adherence to maintenance treatment can reduce reliever overuse and whether cardiovascular risk assessment or targeted therapies might mitigate associated risks.

Sources: Van Vaerenbergh F, Vauterin D, Bloom C, Lahousse L. Cardiovascular effects and mortality of short-acting bronchodilators in asthma and COPD. ERJ Open Res. Published online August 26, 2026. doi:10.1183/23120541.00462-2026

European Respiratory Society. Overuse of inhalers found to increase heart attack risk in asthma and COPD patients. News release. European Respiratory Society; August 27, 2026. Accessed August 28, 2026.