Treatments for metabolic disorders, like diabetes and obesity, can benefit patients with asthma who are at an increased risk of severe asthma due to obesity. Traditional asthma treatments may be less effective in obese patients.
- Obesity increases the risk and severity of asthma.
- Hypoglycemic therapies for type 2 diabetes and obesity may be beneficial for asthma outcomes.
- Including asthma endpoints is recommended to determine whether these drugs are effective and safe for asthma treatment.
People with comorbid asthma and obesity experience more severe symptoms and do not respond as readily to traditionally prescribed inhaled corticosteroids. Hypoglycemia and insulin resistance in obesity alter immune cell function and increase systemic inflammation. Treatments for metabolic dysfunction are being explored for their potential to improve asthma symptoms for people with obesity.
Obesity Exacerbates Asthma Symptoms and Reduces Responsiveness to Inhaled Corticosteroids
Obesity aggravates the inflammatory responses contributing to airway hyperresponsiveness, obstruction, and dangerous asthma exacerbations. This process occurs through visceral adipose tissue promoting inflammatory cytokine release, which impairs beta-cell function and insulin regulation.
Metabolic Dysfunction Treatments Show Promise in Improving Asthma Symptoms for People With Obesity
A review of the metabolic treatments currently approved for prediabetes, type 2 diabetes, and obesity, published in the journal Pulmonary Therapy, found promising evidence that these therapies could benefit asthma symptoms. Weight loss through changes in diet and exercise, or even bariatric surgery, has been shown to improve lung function and reduce inflammation and asthma exacerbations.
Several classes of drugs target the metabolic pathways to improve glucose control, insulin stability, and hypoglycemic risk in diabetes. Although not approved for asthma treatment, some of these therapies can lower the risk of asthma. Metformin, sodium glucose co-transporter 2 channel inhibitors, and glucagon-like peptide-1 receptor agonists are effective glycemic control drugs that reduce inflammatory signaling and improve asthma outcomes.
Balancing Treatment Goals for Obesity, Asthma, and Diabetes in Patients With Comorbidities
Adults with both obesity and asthma need to balance various treatment goals to manage their conditions effectively. These include achieving clinically relevant asthma outcomes, preventing weight gain, minimizing the risk of hypoglycemia, and avoiding unintended severe adverse events.
Although metabolic therapies might improve outcomes for people with comorbid asthma, obesity, and diabetes, there are several conflicting reports that must be further studied. Directly testing asthma-related outcome measures in clinical trials for hypoglycemic agents will elucidate their clinical benefit and proposed use for treating asthma.
Ge, D., Foer, D., & Cahill, K. N. (2023). Utility of Hypoglycemic Agents to Treat Asthma with Comorbid Obesity. Pulm Ther, 9(1), 71-89. https://doi.org/10.1007/s41030-022-00211-x