Frequent use of rescue inhalers, which provide rapid relief during asthma attacks and COPD symptoms, has been associated with an increased risk of cardiovascular disease and death. The more of these inhalers patients used over the course of a year, the higher their risk appeared to be.
The findings were published in ERJ Open Research. The researchers analyzed data from more than 280,000 patients with asthma and chronic obstructive pulmonary disease (COPD) in Belgium. They took into account age, sex, socioeconomic status, smoking, disease severity, other medical conditions, and medications.
The study focused on short-acting bronchodilators — medications that quickly relax the muscles around the airways and temporarily make breathing easier. These include short-acting β2-agonists (SABAs) and short-acting muscarinic antagonists (SAMAs).
Unlike maintenance medications, which are intended to keep the disease under control, rescue inhalers provide rapid but short-term symptom relief. Therefore, a frequent need for them may indicate that asthma or COPD is not adequately controlled.
Among patients with asthma, SABA use was associated with a 12% higher risk of death, while among those with COPD, the increase was 14%, compared with people who did not use these medications. For SAMA use, the increases were even greater: 73% and 36%, respectively.
The association was particularly pronounced depending on the number of inhalers used. Using three or more inhalers per year was associated with a higher risk of death compared with using two or fewer.
The researchers also found an association with cardiovascular conditions, including heart failure, heart attack, and ischemic stroke. People with no previously diagnosed cardiovascular disease appeared to be particularly vulnerable.
The authors emphasize that the findings do not mean that rescue inhalers themselves cause heart attacks or strokes. Frequent use may instead be a marker of poorly controlled asthma or COPD, both of which are already associated with an increased cardiovascular risk. In addition, short-acting bronchodilators can cause a rapid or irregular heartbeat.
Therefore, a persistent need for a rescue inhaler may be more than a matter of convenience — it could be a sign that treatment needs to be reassessed. In such cases, the researchers recommend evaluating lung function, checking adherence to maintenance therapy, and ensuring that the inhaler is being used correctly.
The authors plan to investigate whether the risks associated with excessive inhaler use can be reduced through better adherence to maintenance treatment and closer monitoring of cardiovascular health.
At the same time, experts from the European Respiratory Society emphasize that rescue medications remain an important part of asthma and COPD treatment and can help patients control their symptoms. The problem arises when short-term relief begins to replace effective long-term disease control.
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