Semaglutide, a treatment for Asthma??

Obese patients with Asthma are well known to have poorer control, more frequent exacerbations and resistance to inhaled corticosteroids. Obesity can be multifactorial, with a quick division being those with T2 elevated asthma who are not controlled, do not exercise and secondarily gain weight, or those who have obesity as a primary problem and can then present with either T2 elevated or T2 low disease. The common phenotype for the latter is a younger female with obesity and older onset of asthma. Due to the ICS resistance, therapeutic options are somewhat limited, but evidence clearly has shown that weight loss from behavioral interventions or bariatric surgery can improve asthma outcomes. Diabetes is in itself a proinflammatory condition that increases risk of lung complications as well. As such, treatment with Semaglutide can lead to weight loss and has been shown in diabetic patients to reduce exacerbations better than other diabetic medications(1). Weight loss can mechanistically improve asthma outcomes due to mechanical factors or changing inflammation levels (2). The hypothesis, as shown in previous case series (3) for these cases is that Semaglutide can lead to weight loss, potentially change the inflammatory milieu with different inflammatory mediators in obesity such as IL6, TNF alpha, adipokine leptin, adiponectin and improve asthma outcomes. I describe five patients, in four of whom the addition of Semaglutide for weight loss also significantly improved asthma control and allowed titration down of asthma medications as well as proton pump inhibitors. Unfortunately, in the fifth case, in a patient with concomitant binge eating disorder, there was no weight loss and the benefits were not seen. Semaglutide improves weight loss, and in obese asthmatic patients may control Asthma through a number of mechanisms and should be considered as a therapeutic asthma treatment