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Metabolic dysfunction may exacerbate asthma in adults with obesity

Pre-diabetes and diabetes are risk factors for asthma exacerbations in adults with asthma and obesity, according to a study published in The Journal of Allergy and Clinical Immunology: In Practice.

“Metabolic dysfunction may contribute to worsened asthma in obesity,” Tianshi David Wu, MD, MHS, of the division of pulmonology and critical care and Johns Hopkins University, and colleagues wrote. “The relationship between pre-diabetes and diabetes, metabolic conditions more common in obesity, and asthma outcomes is not well-characterized.”

To examine the association between pre-diabetes and diabetes and rates of asthma exacerbations in adults with obesity, researchers conducted a retrospective cohort study, identifying 5,722 patients aged 18 to 64 years from a claims-based health services database between 2010 and 2015.

Researchers categorized patients according to their HbA1c, with less than 5.6% labeled as “normal,” 5.7% to 6.4% as having pre-diabetes and 6.5% or greater as having diabetes.

Associations between pre-diabetes and diabetes and exacerbations of asthma were then determined, with exacerbations defined as asthma-related hospitalizations, ED visit or being prescribed corticosteroid 14 days before or after an outpatient visit.

Researchers found that higher HbA1c was associated with higher asthma exacerbation rates.

After adjusting for age, sex, region, smoking, medication use and comorbidities, researchers observed that individuals with pre-diabetes had a 27% higher rate (95% CI, 5-52) of asthma exacerbations than those with normal HbA1c, and individuals with diabetes had a 33% higher rate (95% CI, 2-73).

“Our findings implicate pre-diabetes and diabetes as risk factors for exacerbation in obese asthma and represent novel longitudinal evidence that metabolic dysfunction may impact asthma morbidity,” the researchers wrote. “The HbA1c, a nationally-standardized and commonly available blood test, may have value in identifying obese patients at risk for asthma exacerbation.” – by Melissa J. Webb

Disclosures: Wu reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.