A recent observational study suggests that adolescents who are overweight or obese and have asthma have a lower risk of asthma exacerbations after starting a glucagon like peptide-1 receptor agonist (GLP-1RA).1 Adolescents taking a GLP-1RA had 49% fewer asthma exacerbations compared with control patients. Those on a GLP-1RA also had 58% fewer ED visits related to asthma, a 34% risk reduction for needing a systemic corticosteroid, and a 28% risk reduction for needing an inhaled short-action β-2 agonist.
“Among patients who experienced an exacerbation, the proportion with only a single event was 55% in the GLP-1RA group and 44% in the control group,” said senior author Lin-Shien Fu, MD, Chief of Pediatric Nephrology & Immunology, Taichung Veterans General Hospital and Assistant Professor, National Yang-ming Medical University, Taiwan. “However, given the small number of patients with events, this difference did not reach statistical significance.”
Being overweight or obese are key risk factors for more frequent and more severe exacerbations among adolescents with asthma, noted Farrukh Abbas, MD, FCCP, Director of the Severe Asthma Clinic at Virginia Commonwealth University School of Medicine. While GLP1-RAs are increasingly prescribed for weight management in both adolescents and adults, there are only scattered and inconclusive observational data suggesting a potential asthma benefit in adults associated with GLP-1 RA use, Dr. Abbas said. Additionally, he said there are virtually no data on a potential interaction between GLP-1RAs and asthma in adolescents.
“This is an important study that suggests a possible benefit of GLP-1-RA in improving asthma-related outcomes,” Dr. Abbas said. “However, it is important to note that only 36% to 45% of patients were on inhaled corticosteroids, which is the standard of care asthma therapy. Furthermore, there was no significant difference in the exacerbations frequency in patients who had one or more exacerbations in the prior year, suggesting the impact may not be as strong in patients with frequent exacerbations. In addition, a very small number of patients carried a diagnosis of severe persistent asthma, so these findings may not be applicable to patients with severe asthma.”
The researchers conducted the retrospective cohort study using data from the TriNetX global federated health research network between January 2020 and July 2025. The study cohort was largely based in the United States and there were no data on BMI changes after initiating GLP-1RA use.
The study included adolescents who were overweight or obese and had asthma, with or without diabetes. A total of 1,070 adolescents were identified, 535 in the asthma group and 535 matched controls who did not have a GLP-1RA prescription but were receiving documented nonpharmacologic weight management interventions. The groups were balanced for baseline demographic characteristics, BMI, asthma severity, and prior use of asthma- and diabetes-related medications.
The average age of the population was 15.8 years and 56.8% were female. About 20% had comorbid diabetes at baseline and about 25% were taking metformin. Most had mild intermittent asthma (32%), mild persistent asthma (15.5%), moderate persistent asthma (17.4%), or some unspecified degree of asthma (60%). Very few had severe persistent asthma (2.4%), and the rates of asthma exacerbation were less than 6% for the previous year regardless of asthma level.
Fewer patients on a GLP-1RA had acute asthma exacerbations during the 12-month follow-up period compared with patients not on a GLP-1RA (5.4% vs 10.7%). Those in the GLP-1RA arm were also less likely to have an asthma-related ED visit, RR 0.42 (95% CI; 0.19-0.95, P = .04); need a systemic corticosteroid, RR 0.66 (95% CI; 0.54-0.81, P < .001); or be prescribed an inhaled short-acting β-2 agonist, RR 0.72 (95% CI; 0.62-0.84, P < .001).
Whether the observed benefit from GLP-1RAs is the result of weight loss, reduced inflammation, or other weight-independent factors is not clear. Metabolic dysfunction and insulin resistance are common in patients with asthma who are overweight or obese, but the research data contained no longitudinal data on individual BMI changes.
“We have known about the benefits of weight loss on improving asthma-related outcomes from prior studies,” Dr. Abbas said. “This study also generates a hypothesis about the anti-inflammatory benefits of GLP1-RA medications in patients with asthma and obesity that needs to be confirmed in randomized clinical trials, such as one studying the efficacy of semaglutide on asthma-related outcomes in patients with asthma and obesity.”
References
1. Huang YC, Tsai MC, Lin TCC, et al. Glucagonlike peptide-1 receptor agonists and asthma risk in adolescents with obesity. JAMA Netw Open. 2025;8(12):e2551611. doi:10.1001/jamanetworkopen.2025.51611
