The impact of therapy on the risk of asthma in type 2 diabetes

Rayner, Louise; McGovern, Andrew; Sherlock, Julian; Gatenby, Piers; Correa, Ana; Creagh‐Brown, Ben; deLusignan, Simon

doi:10.1111/crj.13011

Cited by 26 publications

(30 citation statements)

References 25 publications

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“…[82][83][84] RCTs in severe asthma are lacking and studies using statins delivered by inhalation are also warranted. 84 Evidence of clinical benefit of metformin in asthma is also growing, [85][86][87] although it has seldom been investigated in real-life clinical settings. In particular, a decrease in asthma exacerbations in response to metformin has been reported in different populations.…”

Section: Current Therapeutic Interventions: Where Do We Stand?mentioning

confidence: 99%

<p>Metabolic Dysfunction and Asthma: Current Perspectives</p>

Pité¹,

Aguiar²,

Morello³

et al. 2020

JAA

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The increasing knowledge of the mechanisms involved in metabolism is shifting the paradigms by which the pathophysiology of many pulmonary diseases is understood. Metabolic dysfunction is recognized in obesity-associated asthma, but other metabolic conditions have been shown to be independently related to asthma. Novel insights have also recently been brought by metabolomics in this filed. The purpose of this review is to discuss current perspectives regarding metabolic dysfunction in asthma, from obesity-related asthma to other metabolic conditions and the role of current pharmacological therapeutic strategies and lifestyle interventions. Obesity is a well-recognized risk factor for asthma across the lifespan, which is generally associated with poorer response to current available treatments, rendering a more severe, refractory disease status. Besides the epidemiological and clinical link, untargeted metabolomics studies have recently supported the obesity-associated asthma phenotype at the molecular level. Not only obesity-related, but also other aspects of metabolic dysregulation can be independently linked to asthma. These include hyperinsulinemia, dyslipidemia and hypertension, which need to be taken into account, even in the non-obese patient. Untargeted metabolomics studies have further highlighted several other metabolic pathways that can be altered in asthma, namely regarding oxidative stress and systemic inflammation, and also suggesting the importance of microbiota in asthma pathogenesis. Considering the reduced response to corticosteroids, other pharmacologic treatments have been shown to be effective regardless of body mass index. Non-pharmacologic treatments (namely weight reduction and dietary changes) may bring substantial benefit to the asthmatic patient. Taken together, this evidence points towards the need to improve our knowledge in this filed and, in particular, to address the influence of environmental factors in metabolic dysfunction and asthma development. Personalized medicine is definitely needed to optimize treatment, including a holistic view of the asthmatic patient in order to set accurate pharmacologic therapy together with dietary, physical exercise and lifestyle interventions.

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Section: Current Therapeutic Interventions: Where Do We Stand?mentioning

confidence: 99%

<p>Metabolic Dysfunction and Asthma: Current Perspectives</p>

Pité¹,

Aguiar²,

Morello³

et al. 2020

JAA

View full text Add to dashboard Cite

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“…20 Studies in several chronic diseases such as diabetes, atrial fibrillation, chronic kidney disease, asthma and chronic obstructive pulmonary disease have been published using RCGP RSC data. [21][22][23][24] Open access Study participants' eligibility All children and adults registered with an RCGP RSC affiliated practice between 1 January 2009 and 1 January 2019 will be extracted from the RCGP RSC database and eligible for inclusion in the studies. People will be excluded if they have less than 12 months of follow-up in the database (unless aged <1 year) and if they have not had at least one consultation during the study period.…”

Section: Data Sourcementioning

confidence: 99%

Epidemiology and management of atopic dermatitis in England: an observational cohort study protocol

et al. 2020

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IntroductionAtopic dermatitis (AD) is one of the most common inflammatory skin conditions in both children and adults. Despite this, contemporary descriptions of the incidence, prevalence and current management of the condition in the UK are lacking.Methods and analysisWe will perform a series of retrospective studies using a large population-based cohort derived from the Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) network database to explore two key research themes: AD epidemiology and AD management.In the epidemiology theme, we will describe the incidence and prevalence of AD in children and adults in England from 2009 to 2018 inclusive. We will stratify findings by age, national Index of Multiple Deprivation (IMD), ethnicity, urban-rural environment and geographic location; and explore independent associations of these features with AD in multivariable models.In the management theme, we will explore healthcare utilisation and treatment in people with AD. Regarding healthcare utilisation, we will evaluate rates of AD-associated primary care visits and specialist dermatology referrals in people with AD. Rates will be stratified by age, gender, socioeconomic IMD quintile and ethnicity. We will describe contemporary treatment by estimating prescribing rates across medication classes used in AD (emollients, topical corticosteroids by potency, topical calcineurin inhibitors, topical antimicrobials, antihistamines, oral corticosteroids and systemic immunomodulatory therapies) overall, and by age and sociodemographic groupings. We will also examine trends in prescribing over the study period. In people first diagnosed with AD during the study period, we will describe differences in treatment escalation by sociodemographic factors using time-to-event analysis.Ethics and disseminationThe Health Research Authority decision tool classed this a study of ‘usual practice’, ethics approval was not required. Study approval was granted by the RCGP RSC Study Approval Committee. Results will be disseminated through peer-reviewed publications.Trial registration numberNCT03823794.

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“…In accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) [11] and MOOSE (Meta-analyses of Observational Studies in Epidemiology) [12] guidelines, we registered the objectives, inclusion criteria, search strategies and methods with the International Prospective Register of Systematic Reviews; PROS-PERO [13], in May 2017, and published it in the open literature [14]. We ensured all included studies had obtained ethical approval.…”

Section: Ethics and Registrationmentioning

confidence: 99%

Type 2 Diabetes and Asthma: Systematic Review of the Bidirectional Relationship

Rayner

McGovern

Creagh‐Brown

et al. 2019

CDR

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Background and objective Obesity is an important contributor to the risk of both asthma and type 2 diabetes (T2DM). However, it has been suggested that T2DM and asthma are also independently associated. The aim of this systematic review was to synthesise the evidence for an independent relationship between T2DM and asthma. Methods MEDLINE and EMBASE were searched for studies reporting the relationship between asthma and T2DM in adults. Given a potential bidirectional relationship, articles relating to T2DM as a risk factor for asthma, and asthma as a risk factor for T2DM were examined separately. Results Eight studies were identified for inclusion in the review (n=2,934,399 participants). Four studies examined incident diabetes in those with asthma. The pooled (random effects model) adjusted hazard ratio for incident T2DM in asthma was 1.37 (95%CI 1.12-1.69; p <0.001) after controlling for BMI. Four studies reported prevalence or incidence rates of asthma in people with T2DM; higher rates of asthma in those with T2DM were reported in all four studies. Meta-analysis of results was not possible due to methodological heterogeneity. The quality of included studies was good, but due to small numbers, publication bias cannot be excluded. Conclusions The published literature suggests a bidirectional independent relationship between T2DM and asthma, although we cannot exclude publication bias.

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The impact of therapy on the risk of asthma in type 2 diabetes

Cited by 26 publications

References 25 publications

<p>Metabolic Dysfunction and Asthma: Current Perspectives</p>

<p>Metabolic Dysfunction and Asthma: Current Perspectives</p>

Epidemiology and management of atopic dermatitis in England: an observational cohort study protocol

Type 2 Diabetes and Asthma: Systematic Review of the Bidirectional Relationship

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