Overusing short-acting reliever inhalers significantly increases the risk of cardiovascular disease, heart attack, stroke, and death in asthma and COPD patients, with risks rising as usage increases, suggesting poor disease control requiring immediate medical review.
- Inhaler overuse affects approximately 1 in 5 asthma patients and 1 in 3 COPD patients, indicating a widespread problem requiring attention.
- SAMA bronchodilators increased death risk by 73% in asthma patients and 36% in COPD patients compared to no use, while SABA increased risk by 12-14%.
- Using three or more inhalers per year was associated with significantly higher cardiovascular risk compared to two or fewer per year.
- Inhaler overuse serves as an alarm signal for uncontrolled airway inflammation and indicates that preventative treatments are not adequately managing the underlying condition.
- Patients with no prior cardiovascular disease history were more vulnerable to developing cardiovascular problems from inhaler overuse.
The association between COPD or asthma and cardiac events is well-known. What is lesser known is overuse of reliever inhalers can increase the risk for those events, including heart failure, heart attack and ischemic stroke.
That’s according to the paper, “Cardiovascular Effects and Mortality of Short-Acting Bronchodilators in Asthma and COPD,” published in ERJ Open Research.
Researchers found that while reliever inhalers can help people breathe more easily when their symptoms are bad, overusing them can be a sign that the patient’s asthma or COPD is not being managed well by preventative treatments.
“Short-acting bronchodilator overuse is common. We know that almost one out of five asthma patients and one out of three COPD patients are overusing these inhalers,” said lead author Lies Lahousse, PhD, of Ghent University, Belgium, in a press release. “In both asthma and COPD, we found that increased use of these inhalers was associated with higher risks of cardiovascular disease and death and the risk continued to rise the more inhalers patients used per year.”
The study analyzed data from more than 226,000 patients with chronic COPD or asthma from a Belgian nationwide cohort between 2017 and 2022. The research team investigated the association between the use of short-acting beta2-agonist (SABA), and short-acting muscarinic antagonist (SAMA), as well as a combination of the two, and cardiovascular risk and mortality.
Compared to no use, SABA bronchodilators alone increased the risk of death by 12% among asthma patients and 14% among COPD patients. The risk of death with SAMA bronchodilators increased by 73% for asthma patients and 36% for COPD patients.
Using three or more inhalers per year for either bronchodilator was associated with increased risk of death compared with two or fewer inhalers per year. Patients with no prior history of cardiovascular disease were found to be more vulnerable to cardiovascular problems because of inhaler overuse.
“Overuse of short-acting bronchodilators is an alarm signal which indicates uncontrolled airway inflammation and requires a medical review of treatment,” said Dr. Lahousse. “It should prompt patients to have their lungs checked and healthcare providers to check adherence and inhaler technique against treatment guidelines.”
The research team is planning to investigate whether reliever overuse can be avoided by stricter adherence to maintenance treatment and whether cardiovascular risk assessment or specific cardiovascular therapies might decrease risks for patients. They also plan to investigate if short-acting bronchodilator overuse in primary care will trigger healthcare providers to check the lungs and monitor disease management more closely.
