Potential for repurposing oral hypertension/diabetes drugs to decrease asthma risk in obesity

Area of Science:

• Pharmacology
• Epidemiology
• Respiratory Medicine

Background:

• Overweight and obesity are linked to increased asthma risk, potentially mediated by adiponectin and peroxisome proliferator-activated receptor pathways.
• Oral medications targeting these pathways, including ACE inhibitors (ACE-I), thiazolidinediones (TZD), and angiotensin receptor blockers (ARB), may mitigate this risk.

Purpose of the Study:

• To investigate the association between the use of ACE-I, TZD, and/or ARB and the risk of new-onset asthma in overweight/obese adults with diabetes mellitus and/or hypertension.

Main Methods:

• Longitudinal analysis of a large cohort of American veterans over 15 years.
• Exposure defined by prescription pickup of ACE-I, TZD, and/or ARB for at least 4 weeks.
• Survival analysis used to determine time to new-onset asthma, with propensity scoring to control for selection bias.

Main Results:

• Use of ACE-I alone, TZD alone, or their combination was associated with a significantly decreased risk of incident asthma (HRs 0.88, 0.74, 0.20; p < 0.001).
• Thiazolidinediones showed a greater risk reduction in racial/ethnic minority subjects compared to White participants (p < 0.001).
• Angiotensin receptor blocker use, alone or with TZD, was associated with an increased risk of incident asthma.

Conclusions:

• Angiotensin-converting enzyme inhibitors and thiazolidinediones are associated with a reduced risk of incident asthma in overweight/obese patients with diabetes and/or hypertension.
• The findings suggest a potential protective role for ACE-I and TZD in asthma prevention within this patient population.