Bronchial asthma and atrial fibrillation: ensuring safe bronchodilator therapy

Bronchial asthma and atrial fibrillation: ensuring safe bronchodilator therapy

U.V. Drutskaya¹, I.S. Kasparyan¹, O.Yu. Agapova¹, O.V. Bondarets¹, I.V. Goloborodova¹, E.V. Smolyakova1,2, K.A. Zykov^1,2,3

Olga Yu. Agapova, e-mail: о.yu.agapova@ya.ru

¹Russian University of Medicine, Moscow

²Research Institute of Pulmonology of the Federal Medical-Biological Agency of Russia, Moscow

³Acad. E.I. Chazov National Medical Research Center of Cardiology, Moscow

The coexistence of bronchial asthma (BA) and atrial fibrillation (AF) is an important clinical challenge in contemporary medicine. This is attributable to the high prevalence of both conditions, shared pathogenetic mechanisms, and their mutually adverse events on disease course. Chronic systemic inflammation and hypoxia provide a common pathophysiological background that may impair asthma control and increase the risk of developing and progressing cardiac rhythm disturbances. Poor asthma control is also associated with a higher risk of arrhythmias, whereas adequate anti-inflammatory therapy may attenuate several pathogenetic factors involved in AF development. Inhaled glucocorticosteroids combined with long-acting bronchodilators remain the cornerstone of asthma management in this patient population. Among bronchodilator agents, long-acting β₂-agonists are characterized by the most favorable safety profile. Modern combination treatment strategies, including the MART approach (maintenance and reliever therapy), help achieve a high level of disease control, reduce exacerbation frequency, and decrease the need for rescue medication. The choice of an optimal drug delivery system is of particular importance in current asthma therapy. Extrafine-particle aerosols provide more effective delivery of the active substance to the peripheral airways, improve disease control, and allow clinically meaningful effects to be achieved with a lower pharmacological burden. Thus, management of patients with concomitant BA and AF should be guided by a personalized approach, with careful consideration of cardiorespiratory comorbidity. Rational selection of anti-inflammatory and bronchodilator therapy, together with the use of modern fixed combinations and effective drug delivery systems, can ensure adequate asthma control while maintaining a high level of cardiovascular safety.

Keywords: bronchial asthma, atrial fibrillation, comorbidity, inhaled glucocorticosteroids, β₂-agonists, antimuscarinic agents, adverse events.

For citation: Drutskaya U.V., Kasparyan I.S., Agapova O.Yu., Bondarets O.V., Goloborodova I.V., Smolyakova E.V., Zykov K.A. Bronchial asthma and atrial fibrillation: ensuring safe bronchodilator therapy. RMJ. 2026;6:–36. DOI: 10.32364/2225-2282-2026-6-6