TY - JOUR
T1 - Metformin Use and Risk of Asthma Exacerbation Among Asthma Patients with Glycemic Dysfunction
AU - Wu, Tianshi David
AU - Fawzy, Ashraf
AU - Akenroye, Ayobami
AU - Keet, Corinne
AU - Hansel, Nadia N.
AU - McCormack, Meredith C.
N1 - Funding Information:
Conflicts of interest: C. Keet discloses research funding from the National Institutes of Health , associate editorship at the Journal of Allergy and Clinical Immunology, board membership at the American Board of Allergy and Immunology, and royalties from Up-to-Date, outside of submitted work. N. N. Hansel discloses research funding from the National Institutes of Health and speakership and advisory fees from Mylan, Theravance, AstraZeneca, and GlaxoSmithKline, outside of submitted work. M. C. McCormack discloses research funding from the National Institutes of Health, consultancies for GlaxoSmithKline and Celegene, and royalties from Up-to-Date, outside of submitted work. The rest of the authors declare that they have no relevant conflicts of interest.
Funding Information:
Research reported in this article was supported by a grant from the COPD Foundation (T.D.W.) and in part by resources from the National Institutes of Health (grant no. K23HL151669) and the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Center for Innovations in Quality, Effectiveness and Safety (CIN 13-413). The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the National Institutes of Health, Department of Veterans Affairs, or the US government.Conflicts of interest: C. Keet discloses research funding from the National Institutes of Health, associate editorship at the Journal of Allergy and Clinical Immunology, board membership at the American Board of Allergy and Immunology, and royalties from Up-to-Date, outside of submitted work. N. N. Hansel discloses research funding from the National Institutes of Health and speakership and advisory fees from Mylan, Theravance, AstraZeneca, and GlaxoSmithKline, outside of submitted work. M. C. McCormack discloses research funding from the National Institutes of Health, consultancies for GlaxoSmithKline and Celegene, and royalties from Up-to-Date, outside of submitted work. The rest of the authors declare that they have no relevant conflicts of interest.
Funding Information:
Research reported in this article was supported by a grant from the COPD Foundation (T.D.W.) and in part by resources from the National Institutes of Health (grant no. K23HL151669 ) and the Department of Veterans Affairs , Veterans Health Administration , Office of Research and Development , Center for Innovations in Quality , Effectiveness and Safety (CIN 13-413). The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the National Institutes of Health, Department of Veterans Affairs, or the US government.
Publisher Copyright:
© 2021 American Academy of Allergy, Asthma & Immunology
PY - 2021/11
Y1 - 2021/11
N2 - Background: Diabetes is associated with worse asthma morbidity. Metformin, which treats diabetes, may have a role among patients with asthma and glycemic dysfunction. Objective: To determine the association between metformin use and asthma exacerbations among patients with diabetes. Methods: We queried the Johns Hopkins electronic health record from April 1, 2013, to May 31, 2018. Adults with asthma and diabetes were followed from first hemoglobin A1c (HbA1c) test to an asthma-related systemic corticosteroid prescription, emergency department (ED) visit, or hospitalization. Multivariable Cox models estimated time to each outcome associated with metformin use, modeled as either time-invariant (status at HbA1c testing) or time-dependent (based on fill data). Mediation of results by HbA1c was assessed. Sensitivity analysis was performed by propensity score matching. Results: The cohort comprised 1749 adults with asthma and diabetes. Metformin use at entry was associated with a lower hazard of asthma-related ED visits (adjusted hazard ratio [aHR], 0.40; 95% CI, 0.22-0.75) but not steroid prescription (aHR, 0.89; 95% CI, 0.70-1.13) or hospitalization (aHR, 0.38; 95% CI, 0.13-1.12). HbA1c did not mediate the association with ED visits. With metformin exposure modeled as time-dependent, metformin use was additionally associated with lower hazard of asthma-related hospitalization (aHR, 0.30; 95% CI, 0.09-0.93). Results were consistent within a subcohort of 698 metformin users matched 1:1 to nonusers by propensity score. Conclusions: Metformin use, independent of glycemic control and obesity, was associated with lower hazard of asthma-related ED visits and hospitalizations. Metformin may have benefit in patients with asthma and glycemic dysfunction.
AB - Background: Diabetes is associated with worse asthma morbidity. Metformin, which treats diabetes, may have a role among patients with asthma and glycemic dysfunction. Objective: To determine the association between metformin use and asthma exacerbations among patients with diabetes. Methods: We queried the Johns Hopkins electronic health record from April 1, 2013, to May 31, 2018. Adults with asthma and diabetes were followed from first hemoglobin A1c (HbA1c) test to an asthma-related systemic corticosteroid prescription, emergency department (ED) visit, or hospitalization. Multivariable Cox models estimated time to each outcome associated with metformin use, modeled as either time-invariant (status at HbA1c testing) or time-dependent (based on fill data). Mediation of results by HbA1c was assessed. Sensitivity analysis was performed by propensity score matching. Results: The cohort comprised 1749 adults with asthma and diabetes. Metformin use at entry was associated with a lower hazard of asthma-related ED visits (adjusted hazard ratio [aHR], 0.40; 95% CI, 0.22-0.75) but not steroid prescription (aHR, 0.89; 95% CI, 0.70-1.13) or hospitalization (aHR, 0.38; 95% CI, 0.13-1.12). HbA1c did not mediate the association with ED visits. With metformin exposure modeled as time-dependent, metformin use was additionally associated with lower hazard of asthma-related hospitalization (aHR, 0.30; 95% CI, 0.09-0.93). Results were consistent within a subcohort of 698 metformin users matched 1:1 to nonusers by propensity score. Conclusions: Metformin use, independent of glycemic control and obesity, was associated with lower hazard of asthma-related ED visits and hospitalizations. Metformin may have benefit in patients with asthma and glycemic dysfunction.
KW - Asthma
KW - Diabetes
KW - Glycemic dysfunction
KW - Metabolic dysfunction
KW - Metformin
KW - Obesity
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U2 - 10.1016/j.jaip.2021.07.007
DO - 10.1016/j.jaip.2021.07.007
M3 - Article
C2 - 34293503
AN - SCOPUS:85111808342
VL - 9
SP - 4014-4020.e4
JO - Journal of Allergy and Clinical Immunology: In Practice
JF - Journal of Allergy and Clinical Immunology: In Practice
SN - 2213-2198
IS - 11
ER -