Metabolic Medications and Youth Hospitalizations for Asthma: A Pre-Post Quasi-Experimental Study

Abstract

Background: Obesity and metabolic dysregulation can lead to adverse outcomes in people with asthma. We hypothesized that pharmacological treatment of metabolic conditions in youth with asthma is associated with lowered risk of severe asthma exacerbations. Research question: Is metabolic pharmacotherapy associated with a lower risk of severe asthma exacerbations among children and young adults with metabolic dysregulation? Study design and methods: This retrospective, quasi-experimental, longitudinal study examined severe asthma exacerbations (those requiring hospitalization or an emergency department [ED] visit) among youth aged 5-25 years with asthma and a history of a metabolic condition (obesity, diabetes, or hypertension). Definitions and diagnoses were based on documented international classification of diseases (ICD) codes. We compared the odds of severe asthma exacerbations before and after the initiation of metabolic pharmocotheraphy using adjusted piecewise generalized linear mixed models. Results: The cohort consisted of 783 patients, predominantly female (73.7%), white (71.6%), and non-Hispanic (90.4%). Metformin was the most frequently prescribed metabolic medication (75.4%). Before initiating metabolic pharmocotheraphy, the odds of severe asthma exacerbations increased by 29% per year (OR=1.29, 95%CI = 1.12-1.49). Conversely, following the commencement of metabolic pharmacotherapy, the odds of severe asthma exacerbations decreased by 66% per year (OR=0.34, 95%CI = 0.23-0.50), showing a statistically significant and marked difference between the pre- and post-treatment periods. Interpretation: Our findings show that the odds of severe asthma excerbations are substantially lower after the initiation of metabolic pharmacotheraphy, highlighting the positive impact that treatment of metabolic syndromes could have in reducing the risk of severe asthma exacerbations. This underscores the interconnectedness of metabolic and respiratory health and the need for further research into effective treatment strategies for individuals with asthma and obesity-related metabolic conditions.