Preview

Meditsinskiy sovet = Medical Council

Advanced search

Influence of antidiabetic drugs on the course of bronchial asthma

https://doi.org/10.21518/ms2025-208

Abstract

Results of modern research show that despite new approaches to the treatment of bronchial asthma (BA) (including new strategies for using combinations of inhaled and biological drugs), about 5-10% of patients belong to the phenotype with persistent resistance to standard therapy, more pronounced bronchial reactivity and, as a result, a tendency to frequent exacerbations. In this regard, it is necessary to study and implement additional methods of BA therapy. Recent research suggests that antidiabetic drugs such as metformin and glucagon-like peptide-1 (GLP-1) agonists may have a positive effect on asthma. A new UK study led by Chloe Bloom of Imperial College London has shown that metformin reduces the risk of asthma attacks by 30%, while adding a GLP-1 agonist to the treatment reduces the risk by a further 40%. In experimental studies, the diabetes drugs metformin and GLP-1 agonists reduced airway inflammation, hyperreactivity and bronchial remodelling. These results highlight the need for further study of the potential of antidiabetic drugs in the treatment of asthma in combination with obesity or type 2 diabetes, and suggest the possibility of repurposing antidiabetic drugs into much-needed alternative treatments for asthma.

About the Authors

V. V. Salukhov
Military Medical Academy named after S.M. Kirov
Russian Federation

Vladimir V. Salukhov, Dr. Sci. (Med.), Professor, Head of the 1st Department and Clinic (Advanced Physician Therapy) named after Academician N.S. Molchanov

6, Akademik Lebedev St., St Petersburg, 194044

 



M. A. Kharitonov
Military Medical Academy named after S.M. Kirov
Russian Federation

Mikhail A. Kharitonov, Dr. Sci. (Med.), Professor, Professor of the 1st Department and Clinic (Advanced Physician Therapy) named after Academician N.S. Molchanov

6, Akademik Lebedev St., St Petersburg, 194044



Yu. V. Rudakov
Military Medical Academy named after S.M. Kirov
Russian Federation

Yuriy V. Rudakov, Cand. Sci. (Med.), Associate Professor of the 1st Department and Clinic (Advanced Physician Therapy) named after Academician N.S. Molchanov

6, Akademik Lebedev St., St Petersburg, 194044



A. V. Nikolaev
Military Medical Academy named after S.M. Kirov
Russian Federation

Andrey V. Nikolaev, Cand. Sci. (Med.), Associate Professor at the 1st Department and Clinic (Advanced Physician Therapy) named after Academician N.S. Molchanov

6, Akademik Lebedev St., St Petersburg, 194044



A. A. Chugunov
Military Medical Academy named after S.M. Kirov
Russian Federation

Aleksandr A. Chugunov, Cand. Sci. (Med.), Lecturer of the 1st Department and Clinic (Advanced Physician Therapy) named after Academician N.S. Molchanov

6, Akademik Lebedev St., St Petersburg, 194044



K. M. Ryazanova
Military Medical Academy named after S.M. Kirov
Russian Federation

Ksenia M. Ryazanova, Cadet of the Faculty of Medical Training (for Land, Missile, and Airborne Forces)

6, Akademik Lebedev St., St Petersburg, 194044



References

1. Avdeev S, Moiseev S, Brovko M, Yavorovskiy A, Umbetova K, Akulkina L et al. Low prevalence of bronchial asthma and chronic obstructive lung disease among intensive care unit patients with COVID-19. Allergy. 2020;75(10):2703–2704. https://doi.org/10.1111/all.14420.

2. Bloom CI, Cullinan P, Wedzicha JA. Asthma Phenotypes and COVID-19 Risk: A Population-based Observational Study. Am J Respir Crit Care Med. 2022;205(1):36–45. https://doi.org/10.1164/rccm.2021071704OC.

3. Pite H, Aguiar L, Morello J, Monteiro EC, Alves AC, Bourbon M, MoraisAlmeida M. Metabolic Dysfunction and Asthma: Current Perspectives. J Asthma Allergy. 2020;13:237–247. https://doi.org/10.2147/JAA.S208823.

4. Yang G, Han YY, Forno E, Yan Q, Rosser F, Chen W, Celedón JC. Glycated Hemoglobin A1c, Lung Function, and Hospitalizations Among Adults with Asthma. J Allergy Clin Immunol Pract. 2020;8(10):3409–3415.e1. https://doi.org/10.1016/j.jaip.2020.06.017.

5. Bartziokas K, Papaioannou AI, Drakopanagiotakis F, Gouveri E, Papanas N, Steiropoulos P. Unraveling the Link between Ιnsulin Resistance and Bronchial Asthma. Biomedicines. 2024;12(2):437. https://doi.org/10.3390/biomedicines12020437.

6. Uppal P, Mohammed SA, Rajashekar S, Giri Ravindran S, Kakarla M, Ausaja Gambo M et al. Type 2 Diabetes Mellitus and Asthma: Pathomechanisms of Their Association and Clinical Implications. Cureus. 2023;15(3):e36047. https://doi.org/10.7759/cureus.36047.

7. Reddel HK, Taylor DR, Bateman ED, Boulet LP, Boushey HA, Busse WW et al. An official American Thoracic Society/European Respiratory Society statement: asthma control and exacerbations: standardizing endpoints for clinical asthma trials and clinical practice. Am J Respir Crit Care Med. 2009;180(1):59–99. https://doi.org/10.1164/rccm.200801-060ST.

8. Cahill KN, Foer D. Borrowing From the Type 2 Diabetes Armamentarium for Asthma. JAMA Intern Med. 2025;185(1):25–27. https://doi.org/10.1001/jamainternmed.2024.5983.

9. Toki S, Newcomb DC, Printz RL, Cahill KN, Boyd KL, Niswender KD, Peebles RS Jr. Glucagon-like peptide-1 receptor agonist inhibits aeroallergen-induced activation of ILC2 and neutrophilic airway inflammation in obese mice. Allergy. 2021;76(11):3433–3445. https://doi.org/10.1111/all.14879.

10. Li CY, Erickson SR, Wu CH. Metformin use and asthma outcomes among patients with concurrent asthma and diabetes. Respirology. 2016;21(7):1210–1218. https://doi.org/10.1111/resp.12818.

11. Wu TD, Keet CA, Fawzy A, Segal JB, Brigham EP, McCormack MC. Association of Metformin Initiation and Risk of Asthma Exacerbation. A Claims-based Cohort Study. Ann Am Thorac Soc. 2019;16(12):1527–1533. https://doi.org/10.1513/AnnalsATS.201812-897OC.

12. Foer D, Beeler PE, Cui J, Karlson EW, Bates DW, Cahill KN. Asthma Exacerbations in Patients with Type 2 Diabetes and Asthma on Glucagonlike Peptide-1 Receptor Agonists. Am J Respir Crit Care Med. 2021;203(7):831–840. https://doi.org/10.1164/rccm.202004-0993OC.

13. Lee B, Man KKC, Wong E, Tan T, Sheikh A, Bloom CI. Antidiabetic Medication and Asthma Attacks. JAMA Intern Med. 2025;185(1):16–25. https://doi.org/10.1001/jamainternmed.2024.5982.

14. Pitocco D, Fuso L, Conte EG, Zaccardi F, Condoluci C, Scavone G et al. The diabetic lung – a new target organ? Rev Diabet Stud. 2012;9(1):23–35. https://doi.org/10.1900/RDS.2012.9.23. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC3448171/.

15. Ge D, Foer D, Cahill KN. Utility of Hypoglycemic Agents to Treat Asthma with Comorbid Obesity. Pulm Ther. 2023;9(1):71–89. https://doi.org/10.1007/s41030-022-00211-x.

16. Park CS, Bang BR, Kwon HS, Moon KA, Kim TB, Lee KY et al. Metformin reduces airway inflammation and remodeling via activation of AMPactivated protein kinase. Biochem Pharmacol. 2012;84(12):1660–1670. https://doi.org/10.1016/j.bcp.2012.09.025.

17. Li C, Erickson SR, Wu C. Metformin use and asthma: Further investigations – Reply. Respirology. 2017;22(1):203–204. https://doi.org/10.1111/resp.12922.

18. LaMoia TE, Shulman GI. Cellular and Molecular Mechanisms of Metformin Action. Endocr Rev. 2021;42(1):77–96. https://doi.org/10.1210/endrev/bnaa023.

19. Ma B, Athari SS, Mehrabi Nasab E, Zhao L. PI3K/AKT/mTOR and TLR4/ MyD88/NF-κB Signaling Inhibitors Attenuate Pathological Mechanisms of Allergic Asthma. Inflammation. 2021;44(5):1895–1907. https://doi.org/10.1007/s10753-021-01466-3.

20. Cheng XY, Li YY, Huang C, Li J, Yao HW. AMP-activated protein kinase reduces inflammatory responses and cellular senescence in pulmonary emphysema. Oncotarget. 2017;8(14):22513–22523. https://doi.org/10.18632/oncotarget.15116.

21. Wang HC, Huang SK. Metformin inhibits IgE- and aryl hydrocarbon receptor-mediated mast cell activation in vitro and in vivo. Eur J Immunol. 2018;48(12):1989–1996. https://doi.org/10.1002/eji.201847706.

22. Calixto MC, Lintomen L, André DM, Leiria LO, Ferreira D, Lellis-Santos C et al. Metformin attenuates the exacerbation of the allergic eosinophilic inflammation in high fat-diet-induced obesity in mice. PLoS ONE. 2013;8(10):e76786. https://doi.org/10.1371/journal.pone.0076786.

23. Rayner LH, Mcgovern A, Sherlock J, Gatenby P, Correa A, Creagh-Brown B, deLusignan S. The impact of therapy on the risk of asthma in type 2 diabetes. Clin Respir J. 2019;13(5):299–305. https://doi.org/10.1111/crj.13011.

24. Rao R, Mei J, Chen H, Yang C. Association of metformin use with asthma development and adverse outcomes: A systematic review and metaanalysis. Medicine. 2024;103(40):e39785. https://doi.org/10.1097/MD.0000000000039785.

25. Kanwar MK, Sunku R, Alruwaili F, Mufti MA, Raji M. Beneficial Effects of Glucagon-Like Peptide-1 Receptor Agonists in Patients With Asthma: A Literature Review. Cureus. 2022;14(10):e30812. https://doi.org/10.7759/ cureus.30812.

26. Bendotti G, Montefusco L, Lunati ME, Usuelli V, Pastore I, Lazzaroni E et al. The anti-inflammatory and immunological properties of GLP-1 Receptor Agonists. Pharmacol Res. 2022;182:106320. https://doi.org/10.1016/j.phrs.2022.106320.

27. Li Z, Li S, Wang N, Xue P, Li Y. Liraglutide, a glucagon-like peptide-1 receptor agonist, suppresses osteoclastogenesis through the inhibition of NF-κB and MAPK pathways via GLP-1R. Biomed Pharmacother. 2020;130:110523. https://doi.org/10.1016/j.biopha.2020.110523.

28. Zhu T, Wu XL, Zhang W, Xiao M. Glucagon Like Peptide-1 (GLP-1) Modulates OVA-Induced Airway Inflammation and Mucus Secretion Involving a Protein Kinase A (PKA)-Dependent Nuclear Factor-κB (NF-κB) Signaling Pathway in Mice. Int J Mol Sci. 2015;16(9):20195–20211. https://doi.org/10.3390/ijms160920195.

29. Mitchell PD, Salter BM, Oliveria JP, El-Gammal A, Tworek D, Smith SG et al. Glucagon-like peptide-1 receptor expression on human eosinophils and its regulation of eosinophil activation. Clin Exp Allergy. 2017;47(3):331–338. https://doi.org/10.1111/cea.12860.

30. Wu AY, Cahill KN, Toki S, Peebles RS Jr. Evaluating the glucagon-like peptide-1 receptor in managing asthma. Curr Opin Allergy Clin Immunol. 2022;22(1):36–41. https://doi.org/10.1097/ACI.0000000000000797.

31. Foer D, Strasser ZH, Cui J, Cahill KN, Boyce JA, Murphy SN, Karlson EW. Association of GLP-1 Receptor Agonists with Chronic Obstructive Pulmonary Disease Exacerbations among Patients with Type 2 Diabetes. Am J Respir Crit Care Med. 2023;208(10):1088–1100. https://doi.org/10.1164/rccm.202303-0491OC.

32. Billington CK, Ojo OO, Penn RB, Ito S. cAMP regulation of airway smooth muscle function. Pulm Pharmacol Ther. 2013;26(1):112–120. https://doi.org/10.1016/j.pupt.2012.05.007.

33. Brandfon S, Eylon A, Khanna D, Parmar MS. Advances in Anti-obesity Pharmacotherapy: Current Treatments, Emerging Therapies, and Challenges. Cureus. 2023;15(10):e46623. https://doi.org/10.7759/cureus.46623.

34. Zhang MQ, Lin C, Cai XL, Jiao RY, Bai SZ, Li ZL et al. The Association between GLP-1 Receptor-Based Agonists and the Incidence of Asthma in Patients with Type 2 Diabetes and/or Obesity: A Meta-Analysis. Biomed Environ Sci. 2024;37(6):607–616. https://doi.org/10.3967/bes2024.067.


Review

For citations:


Salukhov VV, Kharitonov MA, Rudakov YV, Nikolaev AV, Chugunov AA, Ryazanova KM. Influence of antidiabetic drugs on the course of bronchial asthma. Meditsinskiy sovet = Medical Council. 2025;(9):50-56. (In Russ.) https://doi.org/10.21518/ms2025-208

Views: 172


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


ISSN 2079-701X (Print)
ISSN 2658-5790 (Online)