Risk of all-cause mortality or hospitalization for pneumonia associated with inhaled β2-agonists in patients with asthma, COPD or asthma-COPD overlap

β2-agonists provide necessary bronchodilatory action, are recommended by existing clinical practice guidelines and are widely prescribed for patients with these conditions. We examined the risk of all-cause mortality and hospitalization for pneumonia associated with long-or short-acting β2-agonists (LABA or SABA) or ICS (inhaled corticosteroids)/LABA use. In a nested case–control of 185,407 patients, we found no association between β2-agonist use and the risk of pneumonia in patients with asthma, COPD, or asthma-COPD overlap. In contrast, new SABA [HR 1.82 (95% CI 1.04–3.20)] or LABA [HR 2.77 (95% CI 1.22–6.31)] use was associated with an increased risk of all-cause mortality compared to ICS use in COPD patients. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12931-022-02295-0.