Metformin associated with fewer hospitalizations in children with asthma
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Key takeaways:
- Metformin decreases airway hyper-responsiveness and remodeling.
- Patients with asthma were aged 6 to 17 years with type 2 diabetes or elevated blood glucose levels.
- Metformin users had fewer steroid courses.
SAN DIEGO — Children with asthma who used metformin experienced decreases in asthma-related hospitalizations and oral steroid use, according to an abstract presented at the American Thoracic Society International Conference.
The diabetes medication is known for its anti-inflammatory and anti-oxidative properties, Erhan Ararat, MD, director, pediatric pulmonary fellowship, University of Arkansas for Medical Sciences Medical Center and Arkansas Children’s Hospital, and colleagues wrote.
“The link between obesity and asthma is thought to be complex and multifactorial, especially the metabolic complications of obesity such as insulin resistance, metabolic syndrome, and type 2 diabetes,” Ararat said during his presentation.
Patients with asthma and obesity consequently experience greater disease severity, more symptoms and decreased quality of life in addition to decreased response to standard therapies, he continued.
“So, this population needs additional therapies for asthma control,” Ararat said. “Research shows that metformin may have effects on various factors.”
For example, metformin regulates lipid and glucose metabolism and improves insulin resistance. It also decreases airway hyper-responsiveness, decreases the proliferation of airway smooth muscle, regulates the gut microbiome and decreases inflammation through activated protein kinase.
“So, metformin may have potential to be a therapy in asthma patients,” Ararat said.
Previous literature has shown associations between metformin use and reductions in respiratory exacerbations, hospitalizations and mortality among adults with asthma and COPD, Ararat said, but findings were limited for pediatric patients.
“Our aim was to investigate the effects of metformin use on acute asthma outcomes in children with type 2 diabetes and elevated blood glucose levels,” Ararat said.
The study comprised children aged 6 to 17 years, including 915 who used metformin (mean age, 13.7 years; 45% boys; 47% white) and 2,254 who did not (mean age, 13.3 years; 48% boys; 48% white).
In addition to an asthma diagnosis, participants had an outpatient, ER or inpatient encounter; type 2 diabetes or a blood glucose level of 200 mg/dL or higher; and continuous medical and pharmacy enrollment for 6 months before the index date.
“We picked those who actually had an asthma exacerbation ICD code, so it is a very specific group,” Ararat said.
Patients with interstitial pulmonary disease, neoplasm, bronchiectasis, cerebral palsy, cystic fibrosis, dysphagia or congenital malformations of the respiratory system were excluded.
“We excluded some disease processes that may complicate asthma,” Ararat said.
Based on a zero-inflation model, there were no differences between the treatment and control groups in inpatient admissions, ER visits or steroid use.
But in the count model, the treatment group had significantly fewer inpatient admissions (–0.9022; 95% CI, –1.6 to –0.2) and significantly less steroid use (–0.023; 95% CI, –0.41 to –0.04).
“This is the largest study in a pediatric population to our knowledge, and these findings are consistent with our prior research,” Ararat said. “Prospective studies are needed to confirm these findings.”
These studies should explore metformin’s effect on respiratory symptoms, inflammation and lung functions, Ararat continued, as well as whether lean patients can benefit from this treatment.