Inhaled Long-Acting Bronchodilators for COPD: Potential Cardiovascular Risk

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Within the first 30 days of therapy, patients with COPD who began using long-acting bronchodilators had a 1.5-fold increased risk for cardiovascular events.

Patients diagnosed with chronic obstructive pulmonary disease (COPD) may have a higher cardiovascular risk during the new initiation of a long-acting beta-2 agonist (LABA) or long-acting antimuscarinic antagonist (LAMA), according to a study published in JAMA Internal Medicine.

Researchers identified 37,719 individuals in Taiwan with COPD and cardiovascular disease (CVD) and 146,139 matched control patients with COPD only who were newly prescribed either a LABA or LAMA for the treatment of COPD. The purpose of this nested case-control study was to determine whether the risk for CV events could be determined by the new initiation, duration, and use of LABAs and LAMAs in individuals with or without a history of CVD and COPD.

Within the first 30 days of medication being initiated, researchers found that the CV risk was 1.50 times higher in individuals with COPD given a new LABA prescription and 1.52 times higher in those prescribed a LAMA (95% CI, 1.35-1.67 [P <.001] and 95% CI, 1.28-1.80 [P <.001], respectively). In addition, one individual required emergency care or hospitalization during the first 30 days of therapy for every 406 individuals started on a LABA and for every 391 individuals started on a LAMA (95% CI, 303-580 and 254-725, respectively).

The CV risk identified was also persistent during an alternative crossover study performed, as well as in subgroups. However, after the 30-day initiation period, the CV risk was either reduced or absent.

The researchers concluded that “‘[n]ew initiation of LABAs or LAMAs in patients with COPD is associated with an approximate 1.5-fold increased severe cardiovascular risk, irrespective of prior CVD status and history of exacerbations.” Therefore, clinicians should be cautious when considering prescribing and initiating LABA and LAMA therapy in individuals with COPD.

Further, if therapy with a LABA or LAMA is clinically necessary, clinicians should perform a careful CV assessment and closely follow patients during the first 30 days of therapy for any CV symptoms.

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Wang MT, Liou JT, Lin CW, et al. Association of cardiovascular risk with inhaled long-acting bronchodilators in patients with chronic obstructive pulmonary disease [published on January 2, 2018]. JAMA Intern Med. doi:10.1001/jamainternmed.2017.7720