Do GLP-1 medications improve asthma in people with obesity?

People with obesity are at increased risk of having asthma. Population-based studies suggest that women with obesity are at particularly higher risk of asthma (about 15%, vs 8% in women without obesity), and men with obesity are at slightly higher risk of asthma as well (7%, vs 6% in men without obesity). The risk of asthma is higher with higher weight in adults – for every increase in BMI of 5 kg/m2, risk of asthma increases by 32%. For some people, obesity comes first and asthma comes later; for others, obesity begins after the asthma, which could be related to medications used to treat asthma causing weight gain (eg steroids).

Today’s question: Could GLP-1 medications improve asthma in people with obesity?

In retrospective studies, adults with type 2 diabetes (which goes hand in hand with obesity in most cases) and adolescents with obesity using GLP1 medications had fewer asthma exacerbations vs comparator groups not using GLP1s. Another interesting database study found that in people with type 2 diabetes, metformin was associated with a 30% reduced risk of asthma attacks; adding on GLP1 reduced the risk by an additional 40%; neither baseline weight nor blood sugar control were associated with asthma improvements. In a real world database analysis of people with asthma and obesity, people prescribed GLP1 had higher BMI and more uncontrolled asthma at baseline, lost more weight and had improved asthma control vs matched controls.

The protective association between GLP-1RAs and asthma exacerbations likely reflects mechanisms beyond weight loss. Animal studies have found reduction in inflammatory hormones and markers in the lungs with GLP1 treatment, suggesting that a direct effect on airway inflammation may be at play.

BOTTOM LINE: Observational data suggest that GLP-1 medications may improve asthma in people with obesity and/or type 2 diabetes. How much of this benefit is related to weight loss vs anti-inflammatory effects in the lungs is not clear. GLP1 medications may present a promising systemic approach to asthma and related metabolic disease in people with obesity, with the opportunity to improve metabolic health and inflammation in airways in a holistic way. Dedicated studies of GLP1 medications in people with asthma and obesity are needed!

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