Overuse of inhalers found to increase heart attack risk in asthma and COPD patients

 

Overuse of reliever inhalers is associated with higher risks of developing and dying from cardiovascular disease, including heart failure, heart attack and ischemic stroke, in asthma and COPD patients, according to a study published today in ERJ Open Research.

These ‘reliever’ inhalers can help people breathe more easily when their symptoms are particularly bad. However, it is possible to overuse them if the patient’s asthma or COPD is not being managed well by ‘preventer’ treatments.

Professor Lies Lahousse, a lead author of the study from Ghent University, Belgium and Erasmus MC Rotterdam, Netherlands, explains: “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. 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.

“Overuse of short-acting bronchodilator is usually the result of poor disease control, both COPD and uncontrolled asthma are linked to an increased risk of cardiovascular diseases and death.”

The study assessed real-world data from primary and secondary care of over 280,000 COPD and asthma patients in Belgium who used either SABA (short-acting beta-agonist), SAMA (short-acting muscarinic antagonist), both, or no short-acting bronchodilators to manage their condition. Researchers took into account differences in age, sex, socio-economic status, smoking history, nursing home residency, disease severity, and other conditions or medications.

Both SABA and SAMA bronchodilators are often used as reliever therapies by asthma and COPD patients. SABA bronchodilators increased the risk of death by 12% and 14% in asthma and COPD patients respectively compared to no use, the risk of death from SAMA bronchodilators increased by 73% and 36% respectively. The researchers also assessed how the number of inhalers used per year affected cardiovascular health. They found that 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 who did not have any prior history of cardiovascular disease were found to be more vulnerable to cardiovascular problems resulting from inhaler overuse.

Professor Lahousse added: “Overuse of short-acting bronchodilators is an alarm signal which indicates uncontrolled airway inflammation and requires a medical review of treatment. It should prompt patients to have their lungs checked and healthcare providers to check adherence and inhaler technique against treatment guidelines.

“Patients should be informed that short-acting bronchodilators only relax airway muscles briefly. Uncontrolled asthma and COPD are already linked to increased risk of cardiovascular disease and death. When this is combined with overuse of SABA and SAMA bronchodilators – which both cause faster, irregular heart rates as a side effect – these risks become even more pronounced. Over-reliance on this short relief may allow the underlying disease activity progress to go unchecked. Our research should draw clinicians’ attention to the fact that overuse is common and may be associated with adverse effects, even in patients without cardiac history.”

The team is now 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 the risks for patients. They also hope to investigate if short-acting bronchodilator overuse in primary care will trigger healthcare providers to check the lungs and monitor disease management more closely.

Dr Pavol Pobeha from the European Respiratory Society’s expert group on monitoring airway diseases, based at the Pavol Jozef Šafárik University, Košice, Slovakia, who was not involved in the research, said: “There are no cures for asthma or COPD. As a result, the primary goal of clinicians and patients is to manage symptoms and prevent the conditions from worsening. Relief from bronchodilators plays a key role in this management, helping patients to take control of their own health and improve their quality of life, but it is important that they do not become reliant on these therapies.

“We need improved monitoring systems that give a warning signal when patients are overusing short-acting bronchodilators, enabling doctors to support their patients with the best treatment and care to manage symptoms. This will help patients and their healthcare providers to maximise the benefits of their medication whilst minimising risks.”

---

Journal

ERJ Open Research

DOI

10.1183/23120541.00462-2026

People who log their meals most days of the week lose the most weight

  The people who log their meals most days of the week lose the most weight. This is the central finding of a peer-reviewed study of 5132 MyNetDiary users, published on August 13, 2026, in the Journal of Medical Internet Research. Over 6 months, users who tracked food 6-7 days per week lost 11.33% of their body weight on average, about two-thirds more than the 6.84% among users tracking fewer than 2 days per week.

The study at a glance

• 5132 adults using MyNetDiary with a weight-loss goal, followed for 6 months

• Six to seven tracking days per week: 11.33% of body weight lost on average; 80.0% reached the 5% threshold

• Two to three days per week: 7.35% of body weight lost; more than half reached the threshold

• Under two days per week: 6.84% of body weight lost

• Each extra tracking day per week: 35% higher odds of clinically significant loss (aOR 1.35, 95% CI 1.31-1.40)

• Streaks over 90 days: 11.55% of body weight lost (versus 4.21% for streaks of a week or less)

• Full cohort: 9.3 kg (about 20.5 lb) average loss; 70.1% lost at least 5%

The More Days Tracked Consistently, the Higher Chance for Significant Weight Loss

The association followed a staircase pattern, showing how outcomes improved at every step of tracking frequency. Each additional tracking day per week was associated with 35% higher odds of clinically significant weight loss, defined as losing at least 5% of body weight, which is the threshold that clinical guidelines tie to meaningful health improvements (adjusted odds ratio [aOR] 1.35, 95% CI 1.31-1.40; adjusted for age, sex, and starting BMI).

The result that surprised the researchers was that consistency mattered more than perfection. Users who tracked just 2-3 days per week still lost 7.35% of body weight on average, and more than half of them reached the clinically significant threshold. Missing days did not erase the benefit.

Longer Streaks, Bigger Losses

Users who built daily logging streaks longer than 90 days lost 11.55% of body weight on average, with 81.2% reaching clinically significant loss. On the other hand, users whose longest streak was a week or less lost 4.21% of body weight, with 42.3% reaching clinically significant loss. 

Overall Results: 7 in 10 Engaged Users Reached Clinically Significant Loss

Across the full cohort in the study (mean age 42.1; 72.8% women), the average user lost 9.3 kg  (about 20.5 pounds, or 9.5% of body weight), with 70.1%, or roughly 7 in 10, losing at least 5% and 44.8% losing 10% or more of their body weight. The cohort was selected for engagement, that is, every user in it had a weight-loss goal, logged food regularly, and recorded a weight at least monthly.

Sergey Oreshko, cofounder and CEO of MyNetDiary and the first author explains, “The data says something that people trying to lose weight need to hear–you don’t need a perfect record. In our study, every extra day of tracking per week was associated with better odds, and even two or three days a week made a real difference.’

“Dietitians have recommended food journaling for decades, and this shows how consistency can pay off in the real world,” reports Susan Heikkinen, MS, RDN, CDCES, co-author and MyNetDiary-registered dietitian nutritionist. “Every additional day of tracking per week mattered. Whether or not someone is using a weight-loss medication, dietary self-monitoring remains the foundation. And if you fall off for a few days, the message from this data is simple: just pick it back up.”

The authors are direct about the study’s limits. As an observational study, it demonstrates association rather than causation; more motivated users may both track more and lose more. The cohort was an engaged subset, about 1.2% of new signups (roughly 1 in 80), and the results describe that group rather than all app users. Medication use, including glucagon-like peptide-1 (GLP-1) receptor agonists, was not measured and may account for part of the observed loss. As the study was conducted by MyNetDiary’s own team, conflicts of interest are disclosed in the paper, and an anonymized user-level dataset sufficient to replicate the primary analysis has been published with it.

Original article:

Oreshko S, Heikkinen S. Association Between Daily Food-Tracking Frequency and Clinically Significant Weight Loss: Retrospective Cohort Study of 5132 Mobile App Users. J Med Internet Res 2026;28:e98144

URL: https://www.jmir.org/2026/1/e98144

DOI: 10.2196/98144

• Peer-reviewed, open access, anonymized replication dataset published alongside article

• 
  

Workout or nap? Either can help your sleepless brain

 .

Researchers found people who either completed 20 minutes of moderate-to-vigorous exercise or took a 90-minute nap performed about 22 per cent better on memory tests after 30 hours without sleep than those who did neither. The findings, published in Proceedings of the National Academy of Sciences (PNAS), point to practical ways to counter the effects of sleep deprivation.

“Sleep loss affects nearly every aspect of how we think and function, but many people can't simply stop what they're doing and get more sleep,” said senior author Marc Roig, Professor in McGill's School of Physical and Occupational Therapy. “Our findings show that even a brief bout of exercise may help preserve one of our most important cognitive abilities.”

The study involved 54 healthy young adults who stayed awake for 30 consecutive hours under lab supervision. Participants were then assigned to one of three groups: a 20-minute cycling session, a 90-minute nap or a control condition. Three days later, researchers tested their memory for images they had viewed immediately after the intervention. Those who exercised or napped remembered significantly more images than participants who did neither.

Same result, different pathways

While the memory benefits were nearly identical, brain recordings revealed that exercise and napping helped in different ways.

Napping appeared to help the brain recharge, making it easier to take in and remember new information. Exercise, by contrast, helped the brain use its remaining resources more efficiently, without making participants feel more tired.

The findings could eventually inform fatigue-management strategies in workplaces where sleep loss is common and mistakes can have serious consequences, such as health care, transportation and emergency response.

“A nap isn't always possible in the middle of a shift,” said first author Madhura Lotlikar, a doctoral candidate in McGill's Department of Neurology and Neurosurgery. “Exercise is accessible, inexpensive and easy to implement. That makes it a promising tool to help people stay cognitively sharp when sleep is limited.”

The researchers emphasize that exercise cannot replace sleep, but it may help people function better when getting enough rest isn't possible.

About the study

“Protecting episodic memory after sleep loss: Similar benefits of exercise and naps via distinct neural contributions” by Madhura Lotlikar and Marc Roig et al., was published in Proceedings of the National Academy of Sciences of the United States of America.

---

Journal

Proceedings of the National Academy of Sciences

DOI

10.1073/pnas.2528246123 

Article Title

Protecting episodic memory after sleep loss: Similar benefits of exercise and naps via distinct neural contributions

Estrogen-based menopausal hormone therapy = lower Alzheimer’s risk

 Women on regimens of estrogen-only menopausal hormone therapy are at reduced risk of Alzheimer’s disease, a study by Stanford Medicine investigators has found.

Because estrogen-only therapy is generally prescribed for women without a uterus, most of these users presumably had had hysterectomies.

The study, published Aug. 12 in Neurology, is the first to measure the connection between menopausal hormone therapy, or MHT, and reductions in Alzheimer’s-related pathological deposits in autopsied brains. 

Alzheimer’s disease is, by far, the leading cause of dementia in older people. About two-thirds of Alzheimer’s patients are women. Earlier studies have indicated that menopausal hormone therapy raises dementia risk. But the new study suggests otherwise.

“Our study is unique in that we looked at all the standards of Alzheimer’s diagnosis, including the gold-standard outcome: Alzheimer’s-associated hallmarks in autopsied brains,” said Hadi Hosseini, PhD, an associate professor of psychiatry and behavioral sciences who is the study’s senior author. “No one has previously looked at substantial numbers of postmortem Alzheimer’s disease outcomes.”

Jennifer Bruno, PhD, an instructor in psychiatry and behavioral sciences, and former postdoctoral scholar Jacob Shaw, PhD, share lead co-authorship.

“Many conditions impact memory. Clinical diagnoses are often not accurate," Hosseini said. “Although there’s been great progress with bloodborne and cerebrospinal fluid biomarkers, they don’t tell you the amount and precise location of the brain damage. By looking where the actual damage is done — the brain — you can see where the Alzheimer’s-associated defining features are and how many of them are there.”

Evidence from analysis of living participants’ cerebrospinal fluid and blood samples supported the study’s autopsy findings. Estrogen-only menopausal hormone therapy users had 39% lower odds than non-users of receiving a clinical diagnosis of dementia during their lifetimes, and they performed better on memory tests and in their overall ability to function independently. 

The researchers explored two existing databases, numbering 21,462 participants in all, for data on deceased female participants whose brains were autopsied for the presence of two defining pathological features of Alzheimer’s disease: so-called amyloid plaques and neurofibrillary tangles. 

Analyzing results from 258 brain autopsies of women who had reported using menopausal hormone therapy in an estrogen-only formulation, the scientists compared the levels and locations of these two Alzheimer’s hallmarks, along with a third one — the density of individual amyloid plaques — with those in the brains of some 2,701 women who had reported no use of any form of menopausal hormone therapy, and assigned scores to the result.

They found that estrogen-only MHT use was associated with a statistically significant decrease in the presence of these defining Alzheimer’s hallmarks. 

Using a measure known as the odds ratio, the Stanford Medicine team reported a 35% reduction in the odds of a woman’s developing Alzheimer’s disease among estrogen-only menopausal hormone therapy users.

“MHT appears to exert a modest but meaningful and statistically significant protective effect on the risk of developing Alzheimer’s pathology,” Bruno said. “While this is by no means more powerful than such very well-known factors as age, possession of the genetic variant knowns as APOE4 or a history of hypertension, it’s nonetheless quite a consistent effect, spanning multiple Alzheimer’s-related outcomes.” 

The Stanford Medicine study adjusted for these factors, as well as for education and race. The finding of a cognitive benefit for estrogen-only menopausal hormone therapy users carries direct implications for about one-third of all women of menopausal age. By age 60, more than 30% of women have had hysterectomies and no longer have a uterus. Estrogen-only treatment is specifically recommended for these women.

The women in the study skewed older (their average age was 70), and many had had hysterectomies. So, most of them were on estrogen-only regimens. The researchers couldn’t obtain conclusive autopsy findings for dementia risk of women on estrogen-plus-progestin formulations, because the number of autopsied women on such formulations was too small to reach a conclusion about its effect. 

In addition, topical estrogen-only users rather than those on oral estrogen therapy were not counted. 

As a result, the findings are applicable only to estrogen-only formulation, not to estrogen-plus-progestin formulation and not to topical as opposed to oral estrogen administration. And while the association with reduced Alzheimer’s risk is clear, it still doesn’t amount to definitive proof of causality.

“There have been a lot of conflicting findings about MHT’s effects on Alzheimer’s disease outcomes.” Hosseini said. “Different studies may have involved different age ranges of initiating MHT. They may have focused on varying clinical outcomes, used divergent biomarkers or lumped together different MHT formulations, or studied different routes of administration or different durations of use. Some of those studies may not have adequately corrected for various genetic, cardiovascular or other risk factors.”

“Assessments of ‘cognitive decline’ are necessarily somewhat subjective,” Bruno concurred, noting that such declines may depend on who is doing the assessment and may result from any number of different physiological causes ranging from a severe stroke to a bad night’s sleep. 

Early studies suggested that menopausal hormone therapy might be useful for protecting menopausal women from dementia. But other studies that followed yielded inconclusive results. A large analysis published in 2003, the Women’s Health Initiative Memory Study, indicated the opposite effect — estrogen-plus-progestin formulations seemed to increase dementia risk, at least when initiated at an older age. 

The Women’s Health Initiative study also tied the estrogen-plus-progestin combination to increased risk of breast cancer and heart disease. In 2025, the Food and Drug Administration announced the removal of a black-box warning to this effect. But the publicity surrounding the 2003 report had long since sent overall menopausal hormone therapy usage on a roller coaster ride that has yet to be completed. Estimates of women’s use of the therapy during their lifetimes were once close to 27%.

“Now that use estimate has plummeted to below 5%,” Hosseini said. 

“The recent medical literature suggests that MHT is more beneficial when initiated during or soon after menopause,” he said. “The women in our study tended to be older. If anything, our finding underestimated the benefit due to their late initiation of therapy.”

“For a long time,” Bruno said, “the going recommendation was ‘Don’t use MHT for memory decline.’ This study flies in the face of that recommendation.” 

DOI

10.1212/WNL.00000000002184 

Longer meal intervals = faster disease accumulation in older adults

 Older adults who typically had longer intervals between meals accumulated chronic diseases more rapidly over time than those with shorter intervals, according to a study from Karolinska Institutet published in the Journal of Internal Medicine. The association was most pronounced among people aged 78 years and older.

Interest in fasting has increased in recent years, but relatively little is known about how meal timing affects health in older adults. In this new study, researchers investigated whether the duration of the longest daily interval between meals was associated with the accumulation of chronic diseases over time.

The researchers used data from the Swedish National Study on Aging and Care in Kungsholmen (SNAC-K), which includes 2,981 people in Stockholm who were aged 60 years or older at the start of the study. Participants were followed for up to 15 years. The duration of intervals between meals was estimated from participants’ self-reported information about when they typically ate during a 24-hour period.

Association seen across disease types

Longer intervals between meals were associated with faster accumulation of chronic diseases over time. In particular, people whose longest interval between meals during a typical day was 14 to 24 hours accumulated chronic diseases more rapidly than those whose longest interval was 6 to 11.5 hours. The association was observed for the total number of chronic diseases, as well as for cardiovascular and neuropsychiatric diseases, but not for musculoskeletal diseases.

“Much of the research on fasting has been conducted in younger or middle-aged populations. Our findings suggest that the associations may be different in older adults, particularly among the oldest age groups”, says Adrián Carballo Casla, last author of the study and postdoctoral researcher at the Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet.

The researchers emphasise that the study cannot determine cause and effect. Although longer intervals between meals were linked to faster disease accumulation, the study cannot establish whether the fasting pattern independently contributed to this outcome.

For information on funding and any potential conflicts of interest, please see the study.

Publication: “Habitual fasting duration and accelerated multimorbidity in older adults”, Luis Kalmbach, David Abbad-Gomez, Giorgi Beridze, Fernando Rodríguez-Artalejo, Davide Liborio Vetrano, Amaia Calderón-Larrañaga, Adrián Carballo-Casla, Journal of Internal Medicine, online August 20, 2026, doi: 10.1111/joim.70150

---

Journal

Journal of Internal Medicine

DOI

10.1111/joim.70150

A diet high in antioxidants was linked with a lower risk of cervical cancer in women

 In research published in the International Journal of Gynecology & Obstetrics, a diet high in antioxidants was linked with a lower risk of cervical cancer in women.

In the study, investigators analyzed 2003–2018 data from 1,044 US women participating in the National Health and Examination Survey: 174 with and 870 without cervical cancer. With these data, the team looked for an association between cervical cancer and the Composite Dietary Antioxidant Index (CDAI)—a validated composite score that reflects an individual’s intake level of dietary antioxidants, based on dietary recall interviews.

After adjusting for other factors that might affect cancer risk, the researchers found that each 1-unit increase in the CDAI was associated with a 11.4% lower prevalence of cervical cancer. Participants in the highest CDAI tertile had a 55.8% lower prevalence of cervical cancer than those in the lowest tertile. Additional analyses indicated a linear inverse association between the CDAI and the prevalence of cervical cancer.

“These findings suggest that dietary antioxidant intake may play a potential role in the prevention of cervical cancer. However, further prospective studies are needed to confirm this association and clarify the underlying mechanisms,” the authors wrote.

URL upon publication: https://onlinelibrary.wiley.com/doi/10.1002/ijgo.71276

How do body mass index and waist circumference affect mortality in older adults?

In a Journal of the American Geriatrics Society analysis of nationally representative data from 6,905 US adults aged 65 or older followed between 2011–2024, higher body mass index (BMI) was associated with lower mortality risk, whereas higher waist circumference, a marker of abdominal obesity, was independently associated with higher mortality risk after accounting for BMI.

Compared with normal weight, overweight males and males with class I and II obesity (BMI of 30 to less than 40 kg/m2) had 46% and 51% lower risks of mortality, respectively. Additionally, a high waist circumference was also associated with a 24% higher mortality risk in males. Similar patterns were observed in females.

When BMI and waist circumference were evaluated together, being overweight was associated with lower mortality risk regardless of waist circumference among males. Class I and II obesity also remined associated with lower mortality risk exclusively among males with elevated waist circumference. In contrast, being underweight, regardless of waist circumference, and having normal BMI with elevated waist circumference were both associated with higher mortality risk in both males and females.

"BMI and waist circumference provide complementary information about health risk in older adults,” said study co-author, Bryan Blissmer, PhD, of the University of Rhode Island. “Our findings suggest that considering both measures together, rather than relying on BMI alone, may improve mortality risk assessment and support more informed clinical decision-making.”

URL upon publication: https://onlinelibrary.wiley.com/doi/10.1111/jgs.70600