title: Thiazolidinediones and the risk of asthma exacerbation among patients with diabetes: a cohort study.
abstract: BACKGROUND
  Thiazolidinediones are oral diabetes medications that selectively activate peroxisome proliferator-activated receptor gamma and have potent anti-inflammatory properties. While a few studies have found improvements in pulmonary function with exposure to thiazolidinediones, there are no studies of their impact on asthma exacerbations. Our objective was to assess whether exposure to thiazolidinediones was associated with a decreased risk of asthma exacerbation.
  
  
  METHODS
  We performed a cohort study of diabetic Veterans who had a diagnosis of asthma and were taking oral diabetes medications during the period of 10/1/2005 - 9/30/2006. The risk of asthma exacerbations and oral steroid use during 10/1/2006 - 9/30/2007 was compared between patients who were prescribed thiazolidinediones and patients who were on alternative oral diabetes medications. Multivariable logistic regression and negative binomial regression analyses were used to characterize this risk. A sensitivity analysis was performed, restricting our evaluation to patients who were adherent to diabetes therapy.
  
  
  RESULTS
  We identified 2,178 patients who were on thiazolidinediones and 10,700 who were not. Exposure to thiazolidinediones was associated with significant reductions in the risk of asthma exacerbation (OR = 0.79, 95% CI, 0.62 - 0.99) and oral steroid prescription (OR = 0.73, 95% CI 0.63 - 0.84). Among patients who were adherent to diabetes medications, there were more substantial reductions in the risks for asthma exacerbation (OR = 0.64, 95% CI 0.47 - 0.85) and oral steroid prescription (OR = 0.68, 95% CI 0.57 - 0.81).
  
  
  CONCLUSIONS
  Thiazolidinediones may provide a novel anti-inflammatory approach to asthma management by preventing exacerbations and decreasing the use of oral steroids.
authors.affiliation: Health Services Research and Development, VA Puget Sound Health Care System, Department of Veterans Affairs, 1100 Olive Way Suite 1400, 98104-3801 Seattle, WA, USA ; Department of Pulmonary and Cri Care, University of Washington, Seattle, WA, USA.
authors.forename: Seppo T
authors.initials: ST
authors.lastname: Rinne
authors.affiliation: Health Services Research and Development, VA Puget Sound Health Care System, Department of Veterans Affairs, 1100 Olive Way Suite 1400, 98104-3801 Seattle, WA, USA ; Department of Pulmonary and Cri Care, University of Washington, Seattle, WA, USA.
authors.forename: Laura C
authors.initials: LC
authors.lastname: Feemster
authors.affiliation: Health Services Research and Development, VA Puget Sound Health Care System, Department of Veterans Affairs, 1100 Olive Way Suite 1400, 98104-3801 Seattle, WA, USA ; Department of Pulmonary and Cri Care, University of Washington, Seattle, WA, USA.
authors.forename: Bridget F
authors.initials: BF
authors.lastname: Collins
authors.affiliation: Health Services Research and Development, VA Puget Sound Health Care System, Department of Veterans Affairs, 1100 Olive Way Suite 1400, 98104-3801 Seattle, WA, USA ; Department of Pulmonary and Cri Care, University of Washington, Seattle, WA, USA.
authors.forename: David H
authors.initials: DH
authors.lastname: Au
authors.affiliation: Health Services Research and Development, VA Puget Sound Health Care System, Department of Veterans Affairs, 1100 Olive Way Suite 1400, 98104-3801 Seattle, WA, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Perkins
authors.affiliation: Health Services Research and Development, VA Puget Sound Health Care System, Department of Veterans Affairs, 1100 Olive Way Suite 1400, 98104-3801 Seattle, WA, USA ; Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, WA, USA.
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Bryson
authors.affiliation: Gilead Sciences, Inc., Seattle, WA, USA.
authors.forename: Thomas G
authors.initials: TG
authors.lastname: O'Riordan
authors.affiliation: Health Services Research and Development, VA Puget Sound Health Care System, Department of Veterans Affairs, 1100 Olive Way Suite 1400, 98104-3801 Seattle, WA, USA ; Department of Health Services, University of Washington, Seattle, WA, USA.
authors.forename: Chuan-Fen
authors.initials: CF
authors.lastname: Liu
keywords: Asthma; Cohort study; Glitazones; Peroxisome proliferator-activated receptors; Thiazolidinediones