A systematic review covering more than one million patients evaluated respiratory safety signals tied to GLP-1 receptor agonists. The analysis found common upper airway events at rates similar to controls, alongside rare serious signals. For clinical and commercial planning, the key takeaway is that the safety profile appears dominated by non-differential, mild events for most patients, while the rare serious category requires continued pharmacovigilance and careful adjudication. This matters for risk communication, formulary decisions, and the design of real-world studies that can reliably detect low-frequency outcomes. The review’s utility will depend on how the definitions of outcomes were harmonized across studies and how confounding from obesity and baseline respiratory disease was handled.