期刊
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE
卷 206, 期 9, 页码 1096-1106出版社
AMER THORACIC SOC
DOI: 10.1164/rccm.202112-2745OC
关键词
asthma; obesity; insulin resistance; lung function
资金
- NIH [K23 HL138303]
- AstraZeneca
- Boehringer Ingelheim
- Genentech
- GlaxoSmithKline
This study demonstrates that insulin resistance (IR) is common in asthma and is associated with lower lung function, accelerated decline of lung function, and suboptimal responses to bronchodilator and corticosteroid treatments.
Rationale: The role of obesity-associated insulin resistance (IR) in airflow limitation in asthma is uncertain. Objectives: Using data in the Severe Asthma Research Program 3 (SARP-3), we evaluated relationships between homeostatic measure of IR (HOMA-IR), lung function (cross-sectional and longitudinal analyses), and treatment responses to bronchodilators and corticosteroids. Methods: HOMA-IR values were categorized as without (,3.0), moderate (3.0-5.0), or severe (.5.0). Lung function included FEV1 and FVC measured before and after treatment with inhaled albuterol and intramuscular triamcinolone acetonide and yearly for 5 years. Measurements and Main Results: Among 307 participants in SARP-3, 170 (55%) were obese and 140 (46%) had IR. Compared with patients without IR, those with IR had significantly lower values for FEV1 and FVC, and these lower values were not attributable to obesity effects. Compared with patients without IR, those with IR had lower FEV1 responses to beta-adrenergic agonists and systemic corticosteroids. The annualized decline in FEV1 was significantly greater in patients with moderate IR (241 ml/year) and severe IR (232 ml/year,) than in patients without IR (213 ml/year, P, 0.001 for both comparisons). Conclusions: IR is common in asthma and is associated with lower lung function, accelerated loss of lung function, and suboptimal lung function responses to bronchodilator and corticosteroid treatments. Clinical trials in patients with asthma and IR are needed to determine if improving IR might also improve lung function.
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