Association of Metformin Initiation and Risk of Asthma Exacerbation A Claims-based Cohort Study

Tianshi David Wu, Corinne A. Keet, Ashraf Fawzy, Jodi B. Segal, Emily P. Brigham, Meredith C. McCormack

Research output: Contribution to journalArticle

Abstract

Rationale: Diabetes and metabolic syndrome have been associated with worsened asthma control. Metformin improves insulin resistance and metabolic function. Experimental studies suggest that metformin may improve pathologic features of asthma, but evidence of clinical benefit is limited. Objectives: To determine if treatment with metformin in a cohort of individuals with asthma and diabetes is associated with lower risk of asthma exacerbation. Methods: A 6-year retrospective cohort of individuals over age 18 with asthma and diabetes was assembled from a national administrative claims database. New users of metformin were matched to nonusers by propensity score on the basis of demographic, comorbidity, and medication-use characteristics. An exacerbation was defined as an asthma-related hospitalization, emergency department visit, or filling of a systemic corticosteroid prescription within 14 days of an asthma-related ambulatory visit. Cox proportional hazards estimated the change in hazard of asthma exacerbation associated with metformin initiation. Results: In a cohort of 23,920 individuals with asthma and diabetes, metformin initiation was associated with lower hazard of asthma exacerbation (hazard ratio [HR], 0.92; 95% confidence interval [CI], 0.86–0.98), driven by lower hazards of asthma-related emergency department visits (HR, 0.81; 95% CI, 0.74–0.88) and hospitalization (HR, 0.67; 95% CI, 0.50–0.91), without differences in corticosteroid use (HR, 0.96; 95% CI, 0.86–1.03). Conclusions: In an administrative cohort of individuals with asthma and diabetes, metformin initiation was associated with a lower hazard of asthma-related emergency department visits and hospitalizations. These findings suggest a possible benefit of metformin in more severe asthma exacerbations. Investigation within cohorts with more detailed participant characterization is necessary.

Original languageEnglish (US)
Pages (from-to)1527-1533
Number of pages7
JournalAnnals of the American Thoracic Society
Volume16
Issue number12
DOIs
StatePublished - Jan 1 2019

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Metformin
Cohort Studies
Asthma
Confidence Intervals
Hospital Emergency Service
Hospitalization
Adrenal Cortex Hormones
Propensity Score
Prescriptions
Insulin Resistance
Comorbidity

Keywords

  • Administrative data
  • Metabolic dysfunction
  • Metformin
  • Pharmacoepidemiology

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Association of Metformin Initiation and Risk of Asthma Exacerbation A Claims-based Cohort Study. / Wu, Tianshi David; Keet, Corinne A.; Fawzy, Ashraf; Segal, Jodi B.; Brigham, Emily P.; McCormack, Meredith C.

In: Annals of the American Thoracic Society, Vol. 16, No. 12, 01.01.2019, p. 1527-1533.

Research output: Contribution to journalArticle

Wu, Tianshi David ; Keet, Corinne A. ; Fawzy, Ashraf ; Segal, Jodi B. ; Brigham, Emily P. ; McCormack, Meredith C. / Association of Metformin Initiation and Risk of Asthma Exacerbation A Claims-based Cohort Study. In: Annals of the American Thoracic Society. 2019 ; Vol. 16, No. 12. pp. 1527-1533.
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AB - Rationale: Diabetes and metabolic syndrome have been associated with worsened asthma control. Metformin improves insulin resistance and metabolic function. Experimental studies suggest that metformin may improve pathologic features of asthma, but evidence of clinical benefit is limited. Objectives: To determine if treatment with metformin in a cohort of individuals with asthma and diabetes is associated with lower risk of asthma exacerbation. Methods: A 6-year retrospective cohort of individuals over age 18 with asthma and diabetes was assembled from a national administrative claims database. New users of metformin were matched to nonusers by propensity score on the basis of demographic, comorbidity, and medication-use characteristics. An exacerbation was defined as an asthma-related hospitalization, emergency department visit, or filling of a systemic corticosteroid prescription within 14 days of an asthma-related ambulatory visit. Cox proportional hazards estimated the change in hazard of asthma exacerbation associated with metformin initiation. Results: In a cohort of 23,920 individuals with asthma and diabetes, metformin initiation was associated with lower hazard of asthma exacerbation (hazard ratio [HR], 0.92; 95% confidence interval [CI], 0.86–0.98), driven by lower hazards of asthma-related emergency department visits (HR, 0.81; 95% CI, 0.74–0.88) and hospitalization (HR, 0.67; 95% CI, 0.50–0.91), without differences in corticosteroid use (HR, 0.96; 95% CI, 0.86–1.03). Conclusions: In an administrative cohort of individuals with asthma and diabetes, metformin initiation was associated with a lower hazard of asthma-related emergency department visits and hospitalizations. These findings suggest a possible benefit of metformin in more severe asthma exacerbations. Investigation within cohorts with more detailed participant characterization is necessary.

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