Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, Md.
Division of Pediatric Allergy and Immunology, School of Medicine, Johns Hopkins University, Baltimore, Md.
J Allergy Clin Immunol Pract. 2019 Jul-Aug;7(6):1868-1873.e5. doi: 10.1016/j.jaip.2019.02.029. Epub 2019 Mar 8.
Metabolic dysfunction may contribute to worsened asthma in obesity. The relationship between prediabetes and diabetes, metabolic conditions more common in obesity, and asthma outcomes is not well characterized.
We sought to determine the association between prediabetes/diabetes and asthma exacerbations in an obese asthma cohort.
A retrospective cohort of US obese adults with asthma, aged 18-64, was created from a claims-based health services database spanning 2010 to 2015. Individuals with a hemoglobin A1c (HbA1c) measurement were identified, categorized as within normal (<5.6%), prediabetes (5.7% to 6.4%), and diabetes (≥6.5%) ranges. Exacerbations, defined as asthma-related hospitalization, emergency department visit, or corticosteroid prescription ±14 days of an asthma-related outpatient visit, were ascertained. Associations were fit with zero-inflated negative binomial models, adjusted for age, sex, region, smoking, medication use, and comorbidities.
A total of 5722 individuals were identified. Higher HgbA1c was associated with higher asthma exacerbation rates. In the fully adjusted model, compared with individuals with normal HbA1c, those in the prediabetes range had a 27% higher rate (95% confidence interval [CI], 5% to 52%), and those in the diabetes range had a 33% higher rate (95% CI, 2% to 73%).
Prediabetes and diabetes were associated with higher rates of asthma exacerbation among obese adults with asthma. Results support evidence that insulin resistance and metabolic syndrome, metabolic features common in prediabetes/diabetes, can influence asthma morbidity.
代谢功能障碍可能导致肥胖患者的哮喘恶化。糖尿病前期和糖尿病与肥胖更常见的代谢状况之间的关系，以及与哮喘结局的关系尚未得到充分描述。
我们旨在确定肥胖哮喘患者队列中糖尿病前期/糖尿病与哮喘加重之间的关联。
创建了一个来自于 2010 年至 2015 年基于索赔的健康服务数据库的美国肥胖伴哮喘成人的回顾性队列。确定了有血红蛋白 A1c（HbA1c）测量值的个体，并将其分为正常（<5.6%）、糖尿病前期（5.7%-6.4%）和糖尿病（≥6.5%）范围。哮喘加重的定义为哮喘相关住院、急诊就诊或皮质类固醇处方±14 天的哮喘相关门诊就诊。使用零膨胀负二项式模型进行关联分析，调整了年龄、性别、地区、吸烟、药物使用和合并症。
共确定了 5722 名个体。较高的 HgbA1c 与更高的哮喘加重率相关。在完全调整的模型中，与 HbA1c 正常的个体相比，糖尿病前期范围的个体哮喘加重率高 27%（95%置信区间，5%-52%），糖尿病范围的个体哮喘加重率高 33%（95%置信区间，2%-73%）。
肥胖伴哮喘的成年人中，糖尿病前期和糖尿病与更高的哮喘加重率相关。结果支持了这样一种证据，即胰岛素抵抗和代谢综合征等糖尿病前期/糖尿病的常见代谢特征可能会影响哮喘的发病率。
