Cardiovascular effects and mortality of short-acting bronchodilators in asthma and COPD

Background Prior research has focused on short-acting beta 2 -agonist (SABA) overuse-related adverse outcomes in asthma patients. Evidence on the association between use of short-acting bronchodilators in general and cardiovascular events in asthma/COPD populations remains limited. Methods Adult patients with chronic treatment of asthma or COPD were identified in a Belgian nationwide cohort between 2017–2022. A Cox model adjusted for age, sex, smoking, socio-economic status, exacerbation history, comorbidities and medication use, was used to investigate the association between SABA, short-acting muscarinic antagonist (SAMA) and SABA+SAMA use with cardiovascular risk and all-cause mortality. Results The cohort included 226 314 asthma patients (mean age 57.8 years, 60.5% females) and 57 446 COPD patients (mean age 72.2 years, 38.0% females). Compared with no use, SAMA and SABA+SAMA use (1–2 and ≥3 canisters/baseline year) was associated with increased heart failure (1.2 to 1.4-fold), arrhythmia (1.1–1.4-fold) and mortality risk (1.1–1.7-fold) in asthma and COPD patients. Among asthma patients, use of 1–2 and ≥3 SABA+SAMA canisters/year were additionally associated with increased myocardial infarction (1.2–1.4-fold) and ischemic stroke risk (1.2–1.3-fold), and ≥3 SABA+SAMA with a 1.4-fold myocardial infarction risk in COPD patients. Compared with no SABA users, ≥3 SABA canisters/year was associated with a 1.1-fold increased heart failure and mortality risk in asthma and COPD patients, while no increased risks were observed for 1–2 SABA canisters. Conclusion Increased use of SAMA or SABA+SAMA was associated with increased risks of cardiovascular events and mortality in patients with asthma and COPD. Collecting ≥3 SABA canisters/year was associated with increased mortality.