Pham Hewlett, Koehl Rachelle, Woo Han, Wu Tianshi David, Qiu Anna Yue, Brigham Emily P, Hansel Nadia N, McCormack Meredith C
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
J Asthma Allergy. 2025 Apr 28;18:649-654. doi: 10.2147/JAA.S498269. eCollection 2025.
To examine the relationship between Hemoglobin A1c (HbA1c) and asthma outcomes in an urban cohort of children with asthma.
The AIRWEIGHS Study was a randomized controlled clinical trial of an air cleaner intervention testing the hypothesis that overweight/obese children would experience greater improvement in asthma control compared to normal weight children. The study enrolled 164 children with asthma from Baltimore, MD and assessed HbA1c levels and asthma outcomes during clinic visits at baseline and three months. HbA1c levels were analyzed as a continuous measure and categorized as either normal (<5.7%) or consistent with pre-diabetes (≥5.7%). Asthma outcomes included standardized questionnaires, spirometry, and fractional exhaled nitric oxide (FeNO). Generalized Estimating Equation (GEE) regression models were used to analyze the association between the HbA1c and asthma outcomes.
Participants included 164 children with an average age of 11 (± 2) years, predominately African American (85%), male (59%), moderate or severe asthma by NAEPP criteria (59%), households with an income below $34,999 (60%), publicly insured (83%), and overweight/obese (61%). 52 participants were excluded from the analysis due to unsuccessful blood draws or participant refusal. Twenty of 112 distinct participants (18%) had HbA1c measurements ≥5.7%, consistent with prediabetes. Increased HbA1c levels were associated with worse asthma control as indicated by an increase in the Asthma Therapy Assessment Questionnaire (β-0.74 p<0.05). In the interaction analysis, BMI percentile had a significant interaction with HbA1c such that HbA1c had a stronger association with maximum symptoms days and exacerbation risk among children with lower versus higher BMI percentile values.
Higher HbA1c levels were associated with worse asthma control among children with asthma, adding to evidence that metabolic dysfunction may influence asthma morbidity. Additionally, HbA1c could have a stronger influence among non-obese children with underlying metabolic dysfunction, suggesting the need for future studies to investigate metabolic pathways in asthma.
研究城市哮喘儿童队列中糖化血红蛋白（HbA1c）与哮喘结局之间的关系。
AIRWEIGHS研究是一项空气净化器干预的随机对照临床试验，检验的假设是超重/肥胖儿童相比正常体重儿童在哮喘控制方面会有更大改善。该研究招募了来自马里兰州巴尔的摩的164名哮喘儿童，并在基线和三个月的门诊就诊期间评估了HbA1c水平和哮喘结局。HbA1c水平作为连续指标进行分析，并分为正常（<5.7%）或与糖尿病前期一致（≥5.7%）。哮喘结局包括标准化问卷、肺功能测定和呼出一氧化氮分数（FeNO）。使用广义估计方程（GEE）回归模型分析HbA1c与哮喘结局之间的关联。
参与者包括164名平均年龄为11（±2）岁的儿童，主要为非裔美国人（85%），男性（59%），根据美国国家哮喘教育与预防计划（NAEPP）标准为中度或重度哮喘（59%），家庭收入低于34,999美元（60%），参加公共保险（83%），超重/肥胖（61%）。由于采血不成功或参与者拒绝，52名参与者被排除在分析之外。112名不同参与者中有20名（18%）的HbA1c测量值≥5.7%，与糖尿病前期一致。如哮喘治疗评估问卷所示，HbA1c水平升高与哮喘控制较差相关（β=-0.74，p<0.05）。在交互分析中，BMI百分位数与HbA1c有显著交互作用，因此HbA1c与BMI百分位数较低儿童相比BMI百分位数较高儿童的最大症状天数和加重风险的关联更强。
较高的HbA1c水平与哮喘儿童的哮喘控制较差相关，进一步证明代谢功能障碍可能影响哮喘发病率。此外，HbA1c可能对有潜在代谢功能障碍的非肥胖儿童有更强的影响，这表明未来需要研究调查哮喘中的代谢途径。
