Asia Pac Allergy.  2014 Apr;4(2):99-105. 10.5415/apallergy.2014.4.2.99.

Association of insulin resistance with bronchial hyperreactivity

• Kim KM
• Kim SS
• Lee SH
• Song WJ
• Chang YS
• Min KU
• Cho SH

• KMID: 2397112
• DOI: http://doi.org/10.5415/apallergy.2014.4.2.99

Abstract

BACKGROUND
Several epidemiologic studies showed the significant association of insulin resistance with asthma.
OBJECTIVE
The aim of this study was to evaluate the association of insulin resistance with airway hyperresponsiveness (AHR) in adult population.
METHODS
1,058 subjects who visited to the Seoul National University Hospital Gangnam Center from October 2007 to January 2009 for a routine health check-up were enrolled. All subjects completed a questionnaire, anthropometric measurements such as body mass index (BMI) and waist circumference, blood tests, pulmonary function test, and methacholine bronchial provocation test (MBPT). Insulin resistance was estimated from the homeostasis model of assessment of insulin resistance (HOMA-IR).
RESULTS
Thirty-three subjects (3.1%) had AHR based on MBPT. The subjects with AHR had higher BMI, waist circumference, and HOMA-IR than those without AHR (p < 0.001, p = 0.003, and p = 0.002, respectively). In case of men, fasting insulin level and HOMA-IR had significant correlation with forced expiratory volume in 1 second (%) (r = -0.1440, p = 0.011, and r = -0.1156, p = 0.042, respectively). Fasting insulin level and HOMA-IR were higher in men with AHR than in those without (p = 0.046 and p = 0.040, respectively). In binary logistic regression analysis after adjustment for age, HOMA-IR was the significant risk factor for AHR in men (HOMA-IR: odds ratio [OR], 3.21; 95% confidence interval [CI], 1.00-10.30). In case of women, fasting insulin, glucose level, or insulin resistance had no significant correlation with lung function. BMI, waist circumference, and HOMA-IR were significantly higher in women with AHR than in those without (p = 0.001, p = 0.011, and p = 0.010, respectively). In binary logistic regression analysis after adjustment for age, BMI and HOMA-IR were the significant risk factors for AHR in women (BMI: OR, 2.20; 95% CI, 1.23-3.82; insulin resistance: OR, 1.05; 95% CI, 1.00-1.09).
CONCLUSION
Insulin resistance was significantly associated with bronchial hyperreactivity, which is the most characteristic feature of asthma.

Keyword

Asthma; Obesity; Bronchial hyperreactivity; Insulin resistance

MeSH Terms

Adult
Asthma
Body Mass Index
Bronchial Hyperreactivity*
Bronchial Provocation Tests
Epidemiologic Studies
Fasting
Female
Forced Expiratory Volume
Glucose
Hematologic Tests
Homeostasis
Humans
Insulin Resistance*
Insulin*
Logistic Models
Lung
Male
Methacholine Chloride
Obesity
Odds Ratio
Respiratory Function Tests
Risk Factors
Seoul
Waist Circumference
Glucose
Insulin
Methacholine Chloride

Reference

1. Mannino DM, Homa DM, Akinbami LJ, Moorman JE, Gwynn C, Redd SC. Surveillance for asthma--United States, 1980-1999. MMWR Surveill Summ. 2002; 51:1–13.

2. Ford ES, Mannino DM, Redd SC, Mokdad AH, Mott JA. Body mass index and asthma incidence among USA adults. Eur Respir J. 2004; 24:740–744.

3. Chen Y, Dales R, Jiang Y. The association between obesity and asthma is stronger in nonallergic than allergic adults. Chest. 2006; 130:890–895.

4. Beuther DA, Sutherland ER. Overweight, obesity, and incident asthma: a meta-analysis of prospective epidemiologic studies. Am J Respir Crit Care Med. 2007; 175:661–666.

5. Aaron SD, Fergusson D, Dent R, Chen Y, Vandemheen KL, Dales RE. Effect of weight reduction on respiratory function and airway reactivity in obese women. Chest. 2004; 125:2046–2052.

6. Maniscalco M, Zedda A, Faraone S, Cerbone MR, Cristiano S, Giardiello C, Sofia M. Weight loss and asthma control in severely obese asthmatic females. Respir Med. 2008; 102:102–108.

7. Shore SA. Obesity and asthma: possible mechanisms. J Allergy Clin Immunol. 2008; 121:1087–1093.

8. Hajer GR, van Haeften TW, Visseren FL. Adipose tissue dysfunction in obesity, diabetes, and vascular diseases. Eur Heart J. 2008; 29:2959–2971.

9. Lange P, Groth S, Kastrup J, Mortensen J, Appleyard M, Nyboe J, Jensen G, Schnohr P. Diabetes mellitus, plasma glucose and lung function in a cross-sectional population study. Eur Respir J. 1989; 2:14–19.

10. Lange P, Groth S, Mortensen J, Appleyard M, Nyboe J, Schnohr P, Jensen G. Diabetes mellitus and ventilatory capacity: a five year follow-up study. Eur Respir J. 1990; 3:288–292.

11. Walter RE, Beiser A, Givelber RJ, O'Connor GT, Gottlieb DJ. Association between glycemic state and lung function: the Framingham Heart Study. Am J Respir Crit Care Med. 2003; 167:911–916.

12. Davis WA, Knuiman M, Kendall P, Grange V, Davis TM. Fremantle Diabetes Study. Glycemic exposure is associated with reduced pulmonary function in type 2 diabetes: the Fremantle Diabetes Study. Diabetes Care. 2004; 27:752–757.

13. Lazarus R, Sparrow D, Weiss ST. Impaired ventilatory function and elevated insulin levels in nondiabetic males: the Normative Aging Study. Eur Respir J. 1998; 12:635–640.

14. Lawlor DA, Ebrahim S, Smith GD. Associations of measures of lung function with insulin resistance and Type 2 diabetes: findings from the British Women's Heart and Health Study. Diabetologia. 2004; 47:195–203.

15. Engström G, Hedblad B, Nilsson P, Wollmer P, Berglund G, Janzon L. Lung function, insulin resistance and incidence of cardiovascular disease: a longitudinal cohort study. J Intern Med. 2003; 253:574–581.

16. Al-Shawwa BA, Al-Huniti NH, DeMattia L, Gershan W. Asthma and insulin resistance in morbidly obese children and adolescents. J Asthma. 2007; 44:469–473.

17. Husemoen LL, Glumer C, Lau C, Pisinger C, Mørch LS, Linneberg A. Association of obesity and insulin resistance with asthma and aeroallergen sensitization. Allergy. 2008; 63:575–582.

18. Thuesen BH, Husemoen LL, Hersoug LG, Pisinger C, Linneberg A. Insulin resistance as a predictor of incident asthma-like symptoms in adults. Clin Exp Allergy. 2009; 39:700–707.

19. Ma J, Xiao L, Knowles SB. Obesity, insulin resistance and the prevalence of atopy and asthma in US adults. Allergy. 2010; 65:1455–1463.

20. World Health Organization. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus. Geneva: World Health Organization;1999. p. 20–21.

21. Kim YK, Kim SH, Tak YJ, Jee YK, Lee BJ, Kim SH, Park HW, Jung JW, Bahn JW, Chang YS, Choi DC, Chang SI, Min KU, Kim YY, Cho SH. High prevalence of current asthma and active smoking effect among the elderly. Clin Exp Allergy. 2002; 32:1706–1712.

22. Wallace TM, Levy JC, Matthews DR. Use and abuse of HOMA modeling. Diabetes Care. 2004; 27:1487–1495.

23. Alberti KG, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med. 1998; 15:539–553.

24. Cottam DR, Mattar SG, Barinas-Mitchell E, Eid G, Kuller L, Kelley DE, Schauer PR. The chronic inflammatory hypothesis for the morbidity associated with morbid obesity: implications and effects of weight loss. Obes Surg. 2004; 14:589–600.

25. Hotamisligil GS, Murray DL, Choy LN, Spiegelman BM. Tumor necrosis factor alpha inhibits signaling from the insulin receptor. Proc Natl Acad Sci U S A. 1994; 91:4854–4858.

26. Berry MA, Hargadon B, Shelley M, Parker D, Shaw DE, Green RH, Bradding P, Brightling CE, Wardlaw AJ, Pavord ID. Evidence of a role of tumor necrosis factor alpha in refractory asthma. N Engl J Med. 2006; 354:697–708.

27. Howarth PH, Babu KS, Arshad HS, Lau L, Buckley M, McConnell W, Beckett P, Al Ali M, Chauhan A, Wilson SJ, Reynolds A, Davies DE, Holgate ST. Tumour necrosis factor (TNFalpha) as a novel therapeutic target in symptomatic corticosteroid dependent asthma. Thorax. 2005; 60:1012–1018.

28. Thomas PS, Heywood G. Effects of inhaled tumour necrosis factor alpha in subjects with mild asthma. Thorax. 2002; 57:774–778.

29. Thomas PS, Yates DH, Barnes PJ. Tumor necrosis factor-alpha increases airway responsiveness and sputum neutrophilia in normal human subjects. Am J Respir Crit Care Med. 1995; 152:76–80.