Dr Fernando Holguin Offers Insights on Recognizing Metabolic Syndrome Risk in Pulmonary Disease Management

Fernando Holguin, MD, describes the relationship between comorbid metabolic syndrome and pulmonary disease.

From a provider perspective, you need to encourage patients who have asthma and obesity to lose weight, said Fernando Holguin, MD, a pulmonologist and critical care doctor at the University of Colorado Anschutz Medical Campus. Holguin discussed these topics at this year's American Thoracic Society (ATS) meeting.


How can understanding metabolic syndrome as a risk factor for pulmonary disease translate into provider/patient pulmonary disease management?

We did a study, not too long ago, using data from the Longitudinal Assessment of Bariatric Surgery study. The study had around 2500 people that underwent bariatric surgery, of which about 550 had asthma. Those patients underwent surgery and lost a significant amount of weight and were followed for up to 5 years. What's interesting is that as weight loss happens, asthma control improves. But when you look at those that, in spite of losing weight, continue to have risk factors for metabolic syndrome, regardless of which one those were, those patients remain at a higher risk of losing control. Somehow they didn't really benefit from the weight loss.

I think from a provider perspective, it is the idea that you need to encourage in patients who have asthma and obesity, weight loss, because certainly weight loss in many patients improves metabolic syndrome profiling. They have to lose at least 5% to 8% of baseline body weight. Then if somebody has metabolic syndrome and asthma, there are potentially some newer treatments that could affect both diseases. For example, let me give you an idea of one: liraglutide. Liraglutide, which is a GLP-1 [glucagon-like peptide-1] agonist to improve insulin sensitivity, it’s been used to treat patients with non–insulin dependent diabetes. That's been shown to, for one, enhance weight loss. But also, there are mechanisms that relate to inflammatory pathways and metabolic pathways, whereas GLP-1 can potentially reduce the frequency of exacerbations in patients with metabolic syndrome and obesity. That's been shown mostly epidemiologically, but there's ongoing clinical trials in that space.

The same can be said about metformin. That works more on the managing glycemic space. That drug has been associated with reduced eosinophil exacerbations in people that take it. Again, more epidemiologically, but there's some phase 2 studies that are ongoing. I think it makes sense from a clinician perspective to treat metabolic syndrome and maybe expect—I don't know for certain—maybe expect that they will have some beneficial ramifications into improving their asthma control or their lung function.

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