Division of Pulmonary and Critical Care Medicine.
Division of Pediatric Allergy and Immunology, and.
Ann Am Thorac Soc. 2019 Dec;16(12):1527-1533. doi: 10.1513/AnnalsATS.201812-897OC.
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. To determine if treatment with metformin in a cohort of individuals with asthma and diabetes is associated with lower risk of asthma exacerbation. 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. 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). 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.
糖尿病和代谢综合征与哮喘控制恶化有关。二甲双胍可改善胰岛素抵抗和代谢功能。实验研究表明，二甲双胍可能改善哮喘的病理特征，但临床获益的证据有限。为了确定在患有哮喘和糖尿病的人群中使用二甲双胍治疗是否与哮喘恶化的风险降低相关。从国家行政索赔数据库中组建了一个由 18 岁以上患有哮喘和糖尿病的个体组成的 6 年回顾性队列。根据人口统计学、合并症和药物使用特征，基于倾向评分将新使用二甲双胍的个体与非使用者进行匹配。哮喘相关门诊就诊后 14 天内发生哮喘相关住院、急诊就诊或全身皮质类固醇处方填写的情况定义为哮喘加重。Cox 比例风险估计了与二甲双胍起始相关的哮喘恶化风险的变化。在一个患有哮喘和糖尿病的 23920 名个体的队列中，二甲双胍起始与哮喘恶化的风险降低相关（风险比 [HR]，0.92；95%置信区间 [CI]，0.86-0.98），这主要是由于哮喘相关急诊就诊（HR，0.81；95% CI，0.74-0.88）和住院治疗（HR，0.67；95% CI，0.50-0.91）的风险降低，而皮质类固醇使用无差异（HR，0.96；95% CI，0.86-1.03）。在一个患有哮喘和糖尿病的个体的行政队列中，二甲双胍起始与哮喘相关急诊就诊和住院治疗的风险降低相关。这些发现表明二甲双胍在更严重的哮喘恶化中可能有益。在具有更详细参与者特征的队列中进行研究是必要的。
