GLP-1 receptor agonists in asthma: targeting metabolic-inflammatory crossroads

PURPOSE OF REVIEW: The application of GLP-1 receptor agonists as metabolic modulators is one the most exciting and advancing areas in medicine today. Early studies suggest a positive signal in asthma care in both obese and nonobese patients highlighting their multimodal utility across multiple disease phenotypes. RECENT FINDINGS: Asthmatic patients living with obesity are more likely to experience poor disease control, higher exacerbation rates and poor response to conventional asthma therapies. While weight loss interventions have repeatedly shown benefits in these patients, recent studies demonstrate that modulating insulin resistance may lead to improvement of asthma control, independent of weight. Recent translational/mechanistic/observational studies and meta-analyses provide a basis for pursuing GLP1RAs as putative asthma add-on therapies. This represents a novel area of treatment at the overlap between the inflammatory and metabolic nexus, potentially leading to better outcomes in uncontrolled asthma. SUMMARY: GLP-1RAs are receiving attention as potentially exciting therapies for treatment of asthma patients with comorbid obesity and/or diabetes mellitus; however, the exact mechanisms underpinning their utility in these cohorts are poorly understood. Further randomised controlled and pragmatic trials are needed to define their potential benefits/harms, mechanisms of action and where GLP1RAs might fit into existing treatment pathways for uncontrolled asthma.