Study Links Inhaler Overuse to Increased Heart Attack Risk in Asthma, COPD
Overusing reliever inhalers may be linked to a higher risk of cardiovascular disease and death among people with asthma and chronic obstructive pulmonary disease (COPD), according to a new study published in ERJ Open Research.
Reliever inhalers, also known as short-acting bronchodilators, provide quick relief by relaxing the muscles around the airways. However, frequent use may indicate that the underlying condition is not being adequately controlled with maintenance or “preventer” treatment.
Researchers analysed real-world healthcare data from more than 280,000 asthma and COPD patients in Belgium. The study examined the use of short-acting beta-agonists (SABAs) and short-acting muscarinic antagonists (SAMAs), while accounting for factors including age, sex, smoking, disease severity, socioeconomic status and other medical conditions.
The researchers found that SABA use was associated with a 12% higher risk of death in asthma patients and 14% higher risk in COPD patients, compared with no use. For SAMA medications, the increase was 73% among asthma patients and 36% among COPD patients.
The risk also increased as inhaler use rose. Using three or more reliever inhalers per year was associated with a higher risk of death compared with using two or fewer.
The study linked excessive reliever use with cardiovascular problems including heart failure, heart attack and ischaemic stroke. People without a previous history of cardiovascular disease appeared particularly vulnerable.
Researchers stressed that the findings do not mean reliever inhalers themselves necessarily cause these outcomes. Frequent use can be a warning sign of poorly controlled asthma or COPD, which already increases cardiovascular risk. Some short-acting bronchodilators can also cause faster or irregular heart rates.
Experts say excessive reliance on reliever inhalers should prompt a medical review, including assessment of lung control, medication adherence and inhaler technique. Better monitoring could help identify overuse earlier and ensure patients receive appropriate long-term treatment.
REFERENCE: Frauke Van Vaerenbergh. Et al.; Cardiovascular effects and mortality of short-acting bronchodilators in asthma and COPD; ERJ Open Research; 2026; DOI: https://doi.org/10.1183/23120541.00462-2026
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