Metformin use and respiratory outcomes in asthma-COPD overlap
Abstract Background Metformin is associated with improved respiratory outcomes in asthma; however, metformin in COPD and asthma-COPD overlap (ACO) remains unexplored. Objective To determine the association between metformin use and respiratory outcomes in COPD and ACO. Study design and methods Parti...
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2021-02-01
|
| Series: | Respiratory Research |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12931-021-01658-3 |
| _version_ | 1818576067286269952 |
|---|---|
| author | Tianshi David Wu Ashraf Fawzy Gregory L. Kinney Jessica Bon Maniraj Neupane Vickram Tejwani Nadia N. Hansel Robert A. Wise Nirupama Putcha Meredith C. McCormack |
| author_facet | Tianshi David Wu Ashraf Fawzy Gregory L. Kinney Jessica Bon Maniraj Neupane Vickram Tejwani Nadia N. Hansel Robert A. Wise Nirupama Putcha Meredith C. McCormack |
| author_sort | Tianshi David Wu |
| collection | DOAJ |
| description | Abstract Background Metformin is associated with improved respiratory outcomes in asthma; however, metformin in COPD and asthma-COPD overlap (ACO) remains unexplored. Objective To determine the association between metformin use and respiratory outcomes in COPD and ACO. Study design and methods Participants with COPD (FEV1/FVC < 0.70) in the Genetic Epidemiology of COPD study (COPDGene®) were categorized as ACO (n = 510), defined as concurrent physician-diagnosed asthma before age 40 years, or COPD alone (n = 3459). We estimated the association of baseline metformin use with (1) rate of total and severe respiratory exacerbations during follow-up, (2) cross-sectional St. George’s Respiratory Questionnaire (SGRQ) score, six-minute walk distance (6MWD), and post-bronchodilator FEV1 percent predicted (FEV1pp), and (3) 5-year change in SGRQ, 6MWD, and FEV1pp. We also examined change in SGRQ, 6MWD and FEV1pp among participants who initiated metformin during follow-up (n = 108) compared to persistent metformin non-users (n = 2080). Analyses were adjusted for sociodemographic factors, medications, and comorbidities. Results Among participants with ACO, metformin use was associated with lower rate of total (adjusted incidence rate ratio [aIRR] 0.3; 95% confidence interval [95%CI] 0.11, 0.77) and severe exacerbations (aIRR 0.29; 95%CI 0.10, 0.89). Among participants with COPD alone, there was no association between metformin use with total (aIRR 0.98; 95%CI 0.62, 1.5) or severe exacerbations (aIRR 1.3; 95% CI 0.68, 2.4) (p-interaction < 0.05). Metformin use was associated with lower baseline SGRQ score (adjusted mean difference [aMD] − 2.7; 95%CI − 5.3, − 0.2) overall. Metformin initiation was associated with improved SGRQ score (aMD –10.0; 95% CI − 18.7, − 1.2) among participants with ACO but not COPD alone (p-interaction < 0.05). There was no association between metformin use and 6MWD or FEV1pp in any comparison. Conclusions Metformin use was associated with fewer respiratory exacerbations and improved quality of life among individuals with ACO but not COPD alone. Results suggest a potential role for metformin in ACO which requires further prospective study. Trial Registry: NCT00608764 |
| first_indexed | 2024-12-15T00:49:12Z |
| format | Article |
| id | doaj.art-ea3dc023778b43ee9d438ced6d2a7065 |
| institution | Directory Open Access Journal |
| issn | 1465-993X |
| language | English |
| last_indexed | 2024-12-15T00:49:12Z |
| publishDate | 2021-02-01 |
| publisher | BMC |
| record_format | Article |
| series | Respiratory Research |
| spelling | doaj.art-ea3dc023778b43ee9d438ced6d2a70652022-12-21T22:41:28ZengBMCRespiratory Research1465-993X2021-02-012211810.1186/s12931-021-01658-3Metformin use and respiratory outcomes in asthma-COPD overlapTianshi David Wu0Ashraf Fawzy1Gregory L. Kinney2Jessica Bon3Maniraj Neupane4Vickram Tejwani5Nadia N. Hansel6Robert A. Wise7Nirupama Putcha8Meredith C. McCormack9Section of Pulmonary, Critical Care, and Sleep Medicine, Baylor College of MedicineDivision of Pulmonary and Critical Care Medicine, Johns Hopkins School of MedicineDepartment of Epidemiology, Colorado School of Public HealthDivision of Pulmonary, Allergy, and Critical Care Medicine, University of PittsburghDepartment of Critical Care Medicine, National Institutes of HealthDivision of Pulmonary and Critical Care Medicine, Johns Hopkins School of MedicineDivision of Pulmonary and Critical Care Medicine, Johns Hopkins School of MedicineDivision of Pulmonary and Critical Care Medicine, Johns Hopkins School of MedicineDivision of Pulmonary and Critical Care Medicine, Johns Hopkins School of MedicineDivision of Pulmonary and Critical Care Medicine, Johns Hopkins School of MedicineAbstract Background Metformin is associated with improved respiratory outcomes in asthma; however, metformin in COPD and asthma-COPD overlap (ACO) remains unexplored. Objective To determine the association between metformin use and respiratory outcomes in COPD and ACO. Study design and methods Participants with COPD (FEV1/FVC < 0.70) in the Genetic Epidemiology of COPD study (COPDGene®) were categorized as ACO (n = 510), defined as concurrent physician-diagnosed asthma before age 40 years, or COPD alone (n = 3459). We estimated the association of baseline metformin use with (1) rate of total and severe respiratory exacerbations during follow-up, (2) cross-sectional St. George’s Respiratory Questionnaire (SGRQ) score, six-minute walk distance (6MWD), and post-bronchodilator FEV1 percent predicted (FEV1pp), and (3) 5-year change in SGRQ, 6MWD, and FEV1pp. We also examined change in SGRQ, 6MWD and FEV1pp among participants who initiated metformin during follow-up (n = 108) compared to persistent metformin non-users (n = 2080). Analyses were adjusted for sociodemographic factors, medications, and comorbidities. Results Among participants with ACO, metformin use was associated with lower rate of total (adjusted incidence rate ratio [aIRR] 0.3; 95% confidence interval [95%CI] 0.11, 0.77) and severe exacerbations (aIRR 0.29; 95%CI 0.10, 0.89). Among participants with COPD alone, there was no association between metformin use with total (aIRR 0.98; 95%CI 0.62, 1.5) or severe exacerbations (aIRR 1.3; 95% CI 0.68, 2.4) (p-interaction < 0.05). Metformin use was associated with lower baseline SGRQ score (adjusted mean difference [aMD] − 2.7; 95%CI − 5.3, − 0.2) overall. Metformin initiation was associated with improved SGRQ score (aMD –10.0; 95% CI − 18.7, − 1.2) among participants with ACO but not COPD alone (p-interaction < 0.05). There was no association between metformin use and 6MWD or FEV1pp in any comparison. Conclusions Metformin use was associated with fewer respiratory exacerbations and improved quality of life among individuals with ACO but not COPD alone. Results suggest a potential role for metformin in ACO which requires further prospective study. Trial Registry: NCT00608764https://doi.org/10.1186/s12931-021-01658-3Asthma-COPD overlapExacerbationsMetformin |
| spellingShingle | Tianshi David Wu Ashraf Fawzy Gregory L. Kinney Jessica Bon Maniraj Neupane Vickram Tejwani Nadia N. Hansel Robert A. Wise Nirupama Putcha Meredith C. McCormack Metformin use and respiratory outcomes in asthma-COPD overlap Respiratory Research Asthma-COPD overlap Exacerbations Metformin |
| title | Metformin use and respiratory outcomes in asthma-COPD overlap |
| title_full | Metformin use and respiratory outcomes in asthma-COPD overlap |
| title_fullStr | Metformin use and respiratory outcomes in asthma-COPD overlap |
| title_full_unstemmed | Metformin use and respiratory outcomes in asthma-COPD overlap |
| title_short | Metformin use and respiratory outcomes in asthma-COPD overlap |
| title_sort | metformin use and respiratory outcomes in asthma copd overlap |
| topic | Asthma-COPD overlap Exacerbations Metformin |
| url | https://doi.org/10.1186/s12931-021-01658-3 |
| work_keys_str_mv | AT tianshidavidwu metforminuseandrespiratoryoutcomesinasthmacopdoverlap AT ashraffawzy metforminuseandrespiratoryoutcomesinasthmacopdoverlap AT gregorylkinney metforminuseandrespiratoryoutcomesinasthmacopdoverlap AT jessicabon metforminuseandrespiratoryoutcomesinasthmacopdoverlap AT manirajneupane metforminuseandrespiratoryoutcomesinasthmacopdoverlap AT vickramtejwani metforminuseandrespiratoryoutcomesinasthmacopdoverlap AT nadianhansel metforminuseandrespiratoryoutcomesinasthmacopdoverlap AT robertawise metforminuseandrespiratoryoutcomesinasthmacopdoverlap AT nirupamaputcha metforminuseandrespiratoryoutcomesinasthmacopdoverlap AT meredithcmccormack metforminuseandrespiratoryoutcomesinasthmacopdoverlap |