Homeostatic Measure of Insulin Resistance Is Associated With Future Asthma Exacerbations: A 1-Year Prospective Cohort Study

Si Yang Gao; Ke Deng; Ji Wang; Fan Ding Jin; Yan Li Huang; Zhi Hong Chen; Brian G Oliver; Min Xie; Hua Jing Wan; Ling Qin; Dan Liu; Feng Ming Luo; Alan Chen-Yu Hsu; Wei Min Li; Gang Wang; Lisa G Wood

doi:10.1016/j.jaip.2024.06.034

Homeostatic Measure of Insulin Resistance Is Associated With Future Asthma Exacerbations: A 1-Year Prospective Cohort Study

J Allergy Clin Immunol Pract. 2024 Oct;12(10):2774-2784.e3. doi: 10.1016/j.jaip.2024.06.034. Epub 2024 Jun 27.

Authors

Si Yang Gao¹, Ke Deng¹, Ji Wang¹, Fan Ding Jin¹, Yan Li Huang¹, Zhi Hong Chen², Brian G Oliver³, Min Xie⁴, Hua Jing Wan¹, Ling Qin⁵, Dan Liu¹, Feng Ming Luo¹, Alan Chen-Yu Hsu⁶, Wei Min Li⁷, Gang Wang⁸, Lisa G Wood⁹

Affiliations

¹ Department of Respiratory and Critical Care Medicine, Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Center of Excellence in Severe Asthma and Treatable Traits, State Key Laboratory of Respiratory Health and Multimorbidity, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Laboratory of Pulmonary Immunology and Inflammation, Frontiers Science Center for Disease-Related Molecular Network, Sichuan University, Chengdu, Sichuan, China.
² Department of Respiratory, Zhongshan Hospital, Shanghai Institute of Respiratory Disease, Fudan University, Shanghai, China.
³ School of Life Sciences, University of Technology Sydney, Ultimo, New South Wales, Australia; Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia.
⁴ Department of Respiratory and Critical Care Medicine, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.
⁵ Department of Respiratory and Critical Care Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China.
⁶ Signature Research Program in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore.
⁷ Department of Respiratory and Critical Care Medicine, Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Center of Excellence in Severe Asthma and Treatable Traits, State Key Laboratory of Respiratory Health and Multimorbidity, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Respiratory Microbiome Laboratory, Frontiers Science Center for Disease-Related Molecular Network, Sichuan University, Chengdu, Sichuan, China. Electronic address: [email protected].
⁸ Department of Respiratory and Critical Care Medicine, Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Center of Excellence in Severe Asthma and Treatable Traits, State Key Laboratory of Respiratory Health and Multimorbidity, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Laboratory of Pulmonary Immunology and Inflammation, Frontiers Science Center for Disease-Related Molecular Network, Sichuan University, Chengdu, Sichuan, China. Electronic address: [email protected].
⁹ Hunter Medical Research Institute and School of Biomedical Science and Pharmacy, University of Newcastle, Callaghan, New South Wales, Australia.

PMID: 38944198
DOI: 10.1016/j.jaip.2024.06.034

Abstract

Background: Recent evidence suggests that insulin resistance affects asthma outcomes. However, the effect of the homeostatic measure of insulin resistance (HOMA-IR) on airway inflammation and asthma exacerbations (AEs) is poorly understood.

Objective: To analyze the relationship between HOMA-IR and clinical and inflammatory characteristics in patients with asthma, and the association between HOMA-IR and AEs in the following year.

Methods: A prospective cohort study recruited participants with asthma, who were classified into the HOMA-IR^high group and HOMA-IR^low group based on the cutoff value of 3.80 for HOMA-IR and were observed within 12 months. We evaluated the clinical and inflammatory features and conducted a 1-year follow-up to study the exacerbations. We used negative binomial regression models to analyze the association between HOMA-IR and AEs.

Results: Compared with patients in the HOMA-IR^low group (n = 564), those in the HOMA-IR^high group (n = 61) had higher levels of body mass index, a higher waist circumference and waist-hip ratio, higher triglycerides, lower cholesterol high-density lipoproteins, more neutrophils in the peripheral blood, and elevated IL-5 levels in the induced sputum. Furthermore, patients in the HOMA-IR^high group had a significantly increased risk for moderate to severe AEs (adjusted incidence rate ratio [aIRR] = 2.26; 95% CI, 1.38-3.70), severe AEs (aIRR = 2.42; 95% CI, 1.26-4.67), hospitalization (aIRR = 2.54; 95% CI, 1.20-5.38), and emergency visits (aIRR = 3.04; 95% CI, 1.80-8.53).

Conclusions: The homeostatic measure of insulin resistance was associated with asthma-related clinical features and airway inflammation, and was an independent risk factor for future AEs. Therefore, insulin resistance may have important implications for managing asthma as a potential treatable trait.

Keywords: Asthma; Exacerbation; Insulin resistance.

MeSH terms

Adult
Asthma* / epidemiology
Asthma* / physiopathology
Body Mass Index
Cohort Studies
Disease Progression
Female
Follow-Up Studies
Homeostasis*
Humans
Insulin Resistance*
Interleukin-5
Male
Middle Aged
Prospective Studies

Substances

Interleukin-5