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Synergistic Impact of ICS/LABA and LAMA Therapy on Mortality and Hospitalization in Heart Failure Patients with Asthma-COPD Overlap

Sabah Hadi Sachet1
1Maysan Center for Cardiac Diseases and Surgery, Maysan Health Directorate, Ministry of Health, Maysan, Iraq
DOI: https://doi.org/10.70517/revcc2624113
Published: 20/09/2026
: Sabah Hadi Sachet. Synergistic Impact of ICS/LABA and LAMA Therapy on Mortality and Hospitalization in Heart Failure Patients with Asthma-COPD Overlap. Revista Cultura Científica, 2026 Issue 24. pg. 1369-1378.

Abstract

The clinical intersection of heart failure (HF) and chronic obstructive airway diseases, particularly asthma and chronic obstructive pulmonary disease (COPD), represents a complex cardiopulmonary phenotype that presents substantial diagnostic and therapeutic challenges. This observational registry-based study analyzed 200 patients to examine the association of combined inhaled corticosteroid/long-acting beta-2 agonist (ICS/LABA) plus long-acting muscarinic antagonist (LAMA) therapy with all-cause mortality, hospitalization frequency, and cardiopulmonary clinical characteristics.

Across the 24-month observation period, patients receiving ICS/LABA + LAMA had lower observed mortality than patients receiving ICS/LABA alone, including within the asthma-COPD overlap (ACO) subgroup. However, because treatment assignment was not randomized, these differences should be interpreted as associations rather than definitive causal treatment effects. Multivariable logistic regression identified higher log-transformed N-terminal pro-B-type natriuretic peptide (NT-proBNP) as the strongest independent predictor of frequent hospitalization in the reported model, whereas the treatment coefficients shown in the available regression output were not independently significant.

The clinical findings are biologically consistent with published evidence showing that effective bronchodilation can reduce pulmonary hyperinflation and improve cardiopulmonary mechanics, while inhaled corticosteroid therapy may provide additional benefit in appropriately selected patients with asthma features or eosinophilic inflammation. No clear cardiovascular safety signal was identified in this cohort, although the observational design does not permit definitive conclusions regarding arrhythmia risk or cardiovascular safety. Overall, the results support coordinated cardiopulmonary assessment and individualized inhaled therapy in patients with HF and coexisting obstructive airway disease, while emphasizing the need for prospective randomized studies to determine whether triple inhaled therapy directly reduces mortality or hospitalization in this specific high-risk population.

Keywords: heart failure, asthma-COPD overlap, COPD, asthma, ICS/LABA, LAMA, triple inhaled therapy, NT-proBNP, hospitalization, mortality

Abstract

The clinical intersection of heart failure (HF) and chronic obstructive airway diseases, particularly asthma and chronic obstructive pulmonary disease (COPD), represents a complex cardiopulmonary phenotype that presents substantial diagnostic and therapeutic challenges. This observational registry-based study analyzed 200 patients to examine the association of combined inhaled corticosteroid/long-acting beta-2 agonist (ICS/LABA) plus long-acting muscarinic antagonist (LAMA) therapy with all-cause mortality, hospitalization frequency, and cardiopulmonary clinical characteristics.

Across the 24-month observation period, patients receiving ICS/LABA + LAMA had lower observed mortality than patients receiving ICS/LABA alone, including within the asthma-COPD overlap (ACO) subgroup. However, because treatment assignment was not randomized, these differences should be interpreted as associations rather than definitive causal treatment effects. Multivariable logistic regression identified higher log-transformed N-terminal pro-B-type natriuretic peptide (NT-proBNP) as the strongest independent predictor of frequent hospitalization in the reported model, whereas the treatment coefficients shown in the available regression output were not independently significant.

The clinical findings are biologically consistent with published evidence showing that effective bronchodilation can reduce pulmonary hyperinflation and improve cardiopulmonary mechanics, while inhaled corticosteroid therapy may provide additional benefit in appropriately selected patients with asthma features or eosinophilic inflammation. No clear cardiovascular safety signal was identified in this cohort, although the observational design does not permit definitive conclusions regarding arrhythmia risk or cardiovascular safety. Overall, the results support coordinated cardiopulmonary assessment and individualized inhaled therapy in patients with HF and coexisting obstructive airway disease, while emphasizing the need for prospective randomized studies to determine whether triple inhaled therapy directly reduces mortality or hospitalization in this specific high-risk population.

Keywords: heart failure, asthma-COPD overlap, COPD, asthma, ICS/LABA, LAMA, triple inhaled therapy, NT-proBNP, hospitalization, mortality

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Sabah Hadi Sachet
Maysan Center for Cardiac Diseases and Surgery, Maysan Health Directorate, Ministry of Health, Maysan, Iraq
sbhhadi@yahoo.com

How to cite:

Sabah Hadi Sachet. Synergistic Impact of ICS/LABA and LAMA Therapy on Mortality and Hospitalization in Heart Failure Patients with Asthma-COPD Overlap. Revista Cultura Científica, 2026 Issue 24. pg. 1369-1378.

Publication History

  • Received: 02/07/2026
  • Accepted: 05/09/2026
  • Published: 20/09/2026
Copyright © 2026, Sabah Hadi Sachet. Published by Revista Cultura Científica. This article is published as open access under the Creative Commons Attribution 4.0 International (CC BY 4.0) license (http://creativecommons.org/licenses/by/4.0/).

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