Tianshi David Wu1, Ashraf Fawzy2, Ayobami Akenroye3, Corinne Keet3, Nadia N Hansel4, Meredith C McCormack5. 1. Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Md; Section of Pulmonary, Critical Care, and Sleep Medicine, Baylor College of Medicine, Houston, Texas; Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas. 2. Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Md. 3. Division of Pediatric Allergy and Immunology, Johns Hopkins University School of Medicine, Baltimore, Md. 4. Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Md; Division of Pediatric Allergy and Immunology, Johns Hopkins University School of Medicine, Baltimore, Md. 5. Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Md. Electronic address: mmccor16@jhmi.edu.
Abstract
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.
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.
Authors: David J Lederer; Scott C Bell; Richard D Branson; James D Chalmers; Rachel Marshall; David M Maslove; David E Ost; Naresh M Punjabi; Michael Schatz; Alan R Smyth; Paul W Stewart; Samy Suissa; Alex A Adjei; Cezmi A Akdis; Élie Azoulay; Jan Bakker; Zuhair K Ballas; Philip G Bardin; Esther Barreiro; Rinaldo Bellomo; Jonathan A Bernstein; Vito Brusasco; Timothy G Buchman; Sudhansu Chokroverty; Nancy A Collop; James D Crapo; Dominic A Fitzgerald; Lauren Hale; Nicholas Hart; Felix J Herth; Theodore J Iwashyna; Gisli Jenkins; Martin Kolb; Guy B Marks; Peter Mazzone; J Randall Moorman; Thomas M Murphy; Terry L Noah; Paul Reynolds; Dieter Riemann; Richard E Russell; Aziz Sheikh; Giovanni Sotgiu; Erik R Swenson; Rhonda Szczesniak; Ronald Szymusiak; Jean-Louis Teboul; Jean-Louis Vincent Journal: Ann Am Thorac Soc Date: 2019-01
Authors: Mohammad A Al Sallakh; Eleftheria Vasileiou; Sarah E Rodgers; Ronan A Lyons; Aziz Sheikh; Gwyneth A Davies Journal: Eur Respir J Date: 2017-06-15 Impact factor: 16.671
Authors: Seppo T Rinne; Laura C Feemster; Bridget F Collins; David H Au; Mark Perkins; Christopher L Bryson; Thomas G O'Riordan; Chuan-Fen Liu Journal: Allergy Asthma Clin Immunol Date: 2014-07-03 Impact factor: 3.406