State of the Art Review: Glucagon-Like Peptide-1 in Obesity-Related Asthma

Asthma is a heterogeneous condition characterized by chronic airway inflammation, airway hyperresponsiveness, and mucin hypersecretion. Obesity-related asthma is one phenotype of asthma with significant metabolic dysregulation. A complete understanding of obesity-related asthma remains elusive, but it is most often characterized by the absence of hallmark features of Type-2 (T2) high asthma, such as eosinophilia or elevated exhaled nitric oxide (NO) levels. Patients with obesity-related and T2 low asthma with or without type 2 diabetes mellitus (T2DM) experience worse clinical outcomes, including more severe acute exacerbations. Among the Food and Drug Administration (FDA) approved drug classes for T2DM, there is a growing interest in glucagon-like peptide 1 receptor agonists' (GLP-1RAs) ability to potentially exert effects in the airway. Previous studies found that individuals with T2DM and asthma who were prescribed GLP-1RAs, had decreased asthma exacerbations and improved lung function. However, there remains a gap in understanding GLP-1RAs mechanism of action in the lung and airways to improve pulmonary function. In this review we discuss the potential mechanisms by which GLP-1RAs may impact T2 low asthma and offer a therapeutic option for this highly prevalent disorder.