Obese patients with prediabetes or diabetes are at an increased risk for asthma exacerbation, according to a study published in the Journal of Allergy and Clinical Immunology: In Practice.

Researchers from the study retrospectively used data from MarketScan Commercial Claims and Encounters Database to analyze the association between obesity, asthma, serum hemoglobin A1c (HbA1c) levels, and the prevalence of asthma exacerbation. Patients who had either one inpatient or two outpatient asthma-related classification codes, had a diagnosis of obesity, and had a valid HbA1c measurement were included in the study. Asthma exacerbation was defined as a hospitalization with an asthma diagnosis. Data on basic demographics, comorbidities, and asthma controller medication were also collected.

Of the 5722 patients with asthma and obesity included in this study, 72% were women, the mean age was 49 years old, 55% did not report using an asthma control medication, and the mean Charlson comorbidity index was 0.38. During the course of the study, there were 866 asthma exacerbations, with 45 patients having >2 asthma exacerbation events during the follow-up. In the fully adjusted model, patients with pre-diabetes had a 27% (95% CI, 5%-52%; P =.01) higher rate of asthma exacerbation, and patients with diabetes had a 33% (95% CI, 2%-73%; P =.01) higher rate of asthma exacerbation than patients with normal HbA1c levels.

Limitations of this study included lacking data on potential confounding variables, not including body mass index measurements, and only using diagnostic codes to determine asthma and covariates.

The researchers concluded that patients who are obese, have asthma, and either prediabetes or diabetes have higher rates of asthma exacerbation and that these “findings implicate prediabetes and diabetes as risk factors for exacerbation in obese asthma and represent novel longitudinal evidence that metabolic dysfunction may impact asthma morbidity.”

Disclosures: Several authors report multiple associations with pharmaceutical companies. Please see the original reference for a full list of authors’ disclosures.

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Reference

Wu TD, Brigham EP, Keet CA, Brown TT, Hansel NN, McCormack MC. Association between pre-diabetes/diabetes and asthma exacerbations in a claims-based obese asthma cohort [published online March 8, 2019]. J Allergy Clin Immunol Pract. doi:10.1016/j.jaip.2019.02.029