Glucagon-like peptide 1 (GLP-1) receptor agonists and asthma and COPD exacerbations in adults with diabetes: A systematic review

Jun 6, 2025Respiratory medicine

GLP-1 receptor drugs and asthma or COPD flare-ups in adults with diabetes: A systematic review

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Abstract

GLP-1 receptor agonists are associated with a statistically significant lower risk of asthma and COPD exacerbations compared to sulfonylureas and DPP-4 inhibitors.

A total of 62,678 participants were included in the analysis from six retrospective observational studies.
The incidence rate ratio (IRR) for asthma or COPD exacerbations was 0.52 when comparing GLP-1RA to sulfonylureas.
For GLP-1RA compared to DPP-4 inhibitors, the IRR was 0.63, indicating a lower risk of exacerbations.
GLP-1RA users had an IRR of 0.39 compared to insulin, suggesting a reduced risk of exacerbations.
In a Japanese cohort, GLP-1RA showed a higher risk (IRR 1.24) compared to metformin.

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BACKGROUND AND PURPOSE: Glucagon-like peptide-1 receptor agonists (GLP-1RA) are antihyperglycemic agents used to control type 2 diabetes mellitus (T2DM). Recently, there has been increased recognition of the potential pulmonary protective effects of GLP-1RA. Given the bidirectional association between T2DM and obstructive lung disease (OLD) incidence and progression, our systematic review aimed to determine if GLP-1RA therapy for comorbid T2DM was associated with a decreased risk of asthma and COPD exacerbations, relative to other T2DM treatments.

METHODS: We systematically searched for English-language articles published in Ovid Medline, Embase, Scopus, CENTRAL and CINAHL databases from inception to June 25, 2024. Random effects meta-analysis was used to aggregate data where feasible.

RESULTS: Of 23 full-text manuscripts considered for inclusion, six retrospective observational studies were selected (total N = 62,678). The pooled incidence rate ratios (IRR) of asthma or COPD exacerbations demonstrated a statistically significant lower risk of exacerbations associated with GLP-1RA compared to sulfonylureas (IRR, 95 %CI: 0.52, 0.42-0.64) or dipeptidyl peptidase-4 inhibitors (DPP-4I) (IRR 0.63, 0.47-0.86), but not sodium glucose cotransporter-2 inhibitors (SGLT2I) (IRR 0.66, 0.21-2.05). The risk of exacerbations rate was also lower in GLP-1RA users relative to insulin in a single study (IRR 0.39, 0.26-0.58) and higher compared to metformin in a single Japanese cohort (IRR 1.24, 1.08-1.43).

CONCLUSION: Our systematic review and meta-analysis provides evidence for a reduced risk for asthma and COPD exacerbations associated with GLP-1RA use in adults with OLD and T2DM, relative to sulfonylureas or DPP-4I medications. Future research should focus on confirming our observed relationships in prospective trials.

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Glucagon-like peptide 1 (GLP-1) receptor agonists and asthma and COPD exacerbations in adults with diabetes: A systematic review

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