Safety of Short-acting β2-agonists (SABA) in the management of hospitalized COPD patients with cardiovascular comorbidities

<bold>Background:</bold> SABA are the recommended bronchodilator in acute exacerbation of COPD (AECOPD). COPD and cardiovascular disease often coexist. Moreover, the risk of myocardial infarction and stroke increase following AECOPD. Short-acting bronchodilators may exacerbate the adrenergic effects and increase cardiac risk. The aim of this study is to evaluate the safety of SABA in the management of patients with AECOPD and cardiovascular comorbidities. <bold>Methods:</bold> Data was extracted with MDclone platform from Clalit health services database. All AECOPD hospitalization between 2016 – 2021 were included provided cardiovascular comorbidity was present before hospitalization. Patients were divided into 2 groups: those who receive at least one dose SABA and those who did not. For each subject we matched parallel patient with similar epidemiologic and cardiovascular comorbidities profile. <bold>Results:</bold> There were 3283 subjects with AECOPD and cardiovascular comorbidities. Patients in the non-SABA group had more ischemic heart disease, CHF, and fewer arrhythmias (75% vs 80%, 62% vs 54%, 23% vs 37%, respectively, p<0.001), After matching, there were 1544 patients in each group. Hospital lenth-of-stay and in-hospital mortality were similar. At 30-days, ther risk of MACE (Major adverse cardiovascular event) was similar in both groups. There was a signal for lower all-cause mortality (4.2 vs 2.9%, p=0.046) in the SABA group. <bold>Conclusion:</bold> This study demonstrated that SABA did not increase mortality or future cardiovascular risk and was even related with lower 30 days mortality. These data indicate that SABA can be safely given to AECOPD patient with cardiovascular comorbidities.