Respiratory Adverse Events of Weight-Loss Drugs: A Systematic Review and Meta-Analysis. — VialBase Research
A meta-analysis of 123 studies finds semaglutide carries no increased respiratory-adverse-event risk versus placebo, supporting a reassuring respiratory safety profile.
- Across 123 included studies (screened from 9,086 unique records), liraglutide, semaglutide, tirzepatide, and naltrexone-bupropion were not associated with increased respiratory adverse events versus placebo.
- Respiratory events such as upper respiratory tract infections and nasopharyngitis were common; nasopharyngitis incidence ranged from 4.1% (95% CI 0.7%, 9.3%; tirzepatide, 0-6 months) to over 23.7% (95% CI 19.6%, 28.1%; liraglutide, 13-24 months).
- These respiratory event rates were not clearly associated with drug dose or indication.
- Randomized trials contributing to the analysis had low risk of bias; only 1 of the 123 studies specifically evaluated individuals with asthma.
- Authors concluded there was no evidence of increased respiratory harm from weight-loss drugs, indicating a reassuring respiratory safety profile in the general population.
Summary
This systematic review and meta-analysis searched Medline, Embase, Cochrane, and CINAHL (plus trial registries, without date or language restrictions) to characterize the respiratory adverse events of weight-loss medications, both in general populations and specifically among people with asthma. From 9,086 unique records the authors included 123 studies covering liraglutide, semaglutide, tirzepatide, orlistat, naltrexone-bupropion, phentermine-topiramate, and setmelanotide, and ran random-effects meta-analyses of risk differences versus placebo. The main result was reassuring: the GLP-1-class and combination agents assessed showed no increase in respiratory adverse events compared with placebo.
Key Findings
- Across 123 included studies (screened from 9,086 unique records), liraglutide, semaglutide, tirzepatide, and naltrexone-bupropion were not associated with increased respiratory adverse events versus placebo; insufficient data limited comparisons for the other drugs.
- Respiratory events such as upper respiratory tract infections and nasopharyngitis were common. Nasopharyngitis incidence ranged from 4.1% (95% CI 0.7%, 9.3%; tirzepatide, 0-6 months) to over 23.7% (95% CI 19.6%, 28.1%; liraglutide, 13-24 months).
- These event rates were not clearly associated with drug dose or indication.
- Randomized trials contributing to the analysis had low risk of bias; 122 of the 123 studies evaluated general populations and only 1 specifically evaluated individuals with asthma.
- The authors concluded there was no evidence of increased respiratory harm from weight-loss drugs versus placebo, but noted that evidence focused specifically on people with asthma remains limited.
Relevance to Semaglutide
Because semaglutide is increasingly used in people with obesity — a population in which asthma and other respiratory conditions frequently coexist — its respiratory safety profile is a practical concern. This meta-analysis places semaglutide alongside Liraglutide and Tirzepatide among the agents showing no signal for increased respiratory adverse events relative to placebo, which is reassuring for general use. The important caveat is that evidence in patients who actually have asthma is sparse (just one dedicated study), so the reassurance applies most confidently to general populations rather than to respiratory-disease subgroups.
Citation
Zeng L, Zinmon-Htet C, Hundie T, et al. Respiratory Adverse Events of Weight-Loss Drugs: A Systematic Review and Meta-Analysis. Annals of the American Thoracic Society. 2026. doi:10.1093/annalsats/aaoag177.
See Also
- Parent compound: Semaglutide
- Tirzepatide
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