Atrial Fibrillation: Which Inhalers Are Safe?

Which Inhalers Are Safe For Atrial Fibrillation?   

Dear Dr. Mahler: What are the safest COPD inhalers for someone with atrial fibrillation, who is on Eliquis? Thank You. Ingrid from High Point, NC Dear Ingrid: As you know, atrial fibrillation is an irregular heart rhythm. The upper chambers of the heart (called atria) do not beat in synchrony with the lower chambers (called ventricles). As a result, there is a risk for blood clots to form in the heart. Eliquis is a medication used to reduce the risk of blood clots from forming.
Atrial fibrillation is a common heart disease in COPD

The curved arrows in the right and left atrium (upper chambers) in atrial fibrillation indicate chaotic electrical activity.

In those with atrial fibrillation, the heart rate may be normal or, in some people, may beat fast without any apparent reason. There are two different classes of bronchodilators. These are called beta-agonists and muscarinic antagonists. In general, beta-agonist bronchodilators are more likely to cause the heart to beat faster than muscarinic antagonists. However, both classes are considered safe for those with COPD. In my practice, I use both classes of bronchodilators in those who have atrial fibrillation and COPD. You did not mention whether you are using any inhaler(s) at the present time. Most likely, your health care professional has prescribed albuterol (brand names are ProAir, Proventil, and Ventolin) which is a short-acting beta-agonist medication. This is typically used as needed for shortness of breath. Have you noticed any change in your heart rate or felt any palpitations after you inhale albuterol or a long-acting bronchodilator? If so, you should discuss this with your health care professional. Please note, the advice provided is not a substitute for asking your health care professional about your specific situation. Sincerely, Donald A. Mahler, M.D.

Donald A. Mahler, M.D. is Emeritus Professor of Medicine at Geisel School of Medicine at Dartmouth in Hanover, New Hampshire. He works as a pulmonary physician at Valley Regional Hospital in Claremont, NH, where he is Director of Respiratory Services.