Semaglutide was associated with up to a 40% reduction in asthma attacks and a 20% reduction in chronic obstructive pulmonary disease (COPD) flare-ups compared with sulfonylureas in a real-world analysis of UK electronic health records presented at the European Respiratory Society (ERS) Congress 2026 in Barcelona, Spain, held September 5 to 9.1
GLP-1 receptor agonists are widely used to treat type 2 diabetes and obesity, both common comorbidities in asthma and COPD, increasing the risk of exacerbations, according to the study investigators.1 Prior observational research has suggested GLP-1 receptor agonists may have anti-inflammatory effects and improve lung-related outcomes, but the comparative effectiveness of newer versus older agents, the impact of dose, and any differential response between asthma and COPD had not been described.1
“The effect was strongest with semaglutide, especially in people with asthma, where use of semaglutide appears to be associated with nearly 40% reduction in asthma attacks,” said Chloe Bloom, MD, PhD, clinical associate professor in respiratory epidemiology at the National Heart & Lung Institute, Imperial College London, who led the study.2 “Semaglutide also led to a 20% reduction in COPD flare-ups.”
How did semaglutide reduce airway exacerbations?
Using UK electronic medical records, investigators conducted 4 parallel new-user, active-comparator studies comparing initiators of each GLP-1 receptor agonist, semaglutide, liraglutide, dulaglutide, and exenatide, with initiators of sulfonylureas, another class of diabetes medication.1 Doubly robust inverse probability of treatment weighting was applied to control for confounding factors, including disease severity, body mass index, smoking status, eosinophil count, and comorbidities, and weighted hazard ratios were calculated for airway exacerbations.1 Investigators also assessed effect modification by GLP-1 receptor agonist dose and underlying respiratory condition, asthma or COPD.1
In the semaglutide new-user cohort (n = 22,537), semaglutide initiation was associated with fewer airway exacerbations compared with sulfonylureas (weighted hazard ratio [wHR], 0.76; 95% CI, 0.60-0.96).1 The association was stronger at higher doses, with a wHR of 0.75 (95% CI, 0.58-0.95) at low doses and 0.28 (95% CI, 0.08-1.01) at medium or high doses, and was more pronounced in asthma (wHR, 0.20; 95% CI, 0.05-0.78) than in COPD (wHR, 0.76; 95% CI, 0.58-1.00).1
Were effects more asthma-specific and drug-specific?
No significant associations with airway exacerbations were observed for liraglutide, dulaglutide, or exenatide, regardless of dose or underlying lung disease, despite similarly sized new-user cohorts for each individual agent.1 Investigators said only semaglutide showed a significant reduction in airway exacerbations, with evidence of a dose-response relationship and an association substantially stronger in asthma than in COPD.1
Each GLP-1 receptor agonist cohort included between roughly 20,000 and 22,000 new users compared against sulfonylurea initiators, and investigators applied the same weighting methodology across all 4 comparisons.1 Investigators said the differential findings across agents highlight the value of studying individual GLP-1 receptor agonists separately rather than as a single drug class, and asthma comorbidity may help guide GLP-1 receptor agonist selection in patients managed for diabetes and obesity.1
“This is one of the largest real-world studies to investigate GLP-1 receptor agonists and airways disease, and one of the first to examine whether effects differ between individual GLP-1 receptor agonists,” said Alexander Mathioudakis, MD, PhD, chair of the European Respiratory Society Group on Airway Pharmacology and Treatment and senior lecturer in respiratory medicine at the University of Manchester, who was not involved in the research.2 “It highlights the need to consider metabolic health as part of respiratory care.”
Bloom cautioned the findings should not change treatment decisions on their own, noting people with asthma or COPD should not start GLP-1 receptor agonists specifically for their lung condition outside current prescribing guidance.2 Investigators described the analysis as one of the largest real-world studies of GLP-1 receptor agonists and airways disease, and said the results support including respiratory outcomes, such as asthma attacks and COPD exacerbations, in future trials of metabolic therapies.2
References
Lee B, Cahill K, Bloom C. The differential effects of GLP-1 based therapies in airways disease. Presented at: European Respiratory Society (ERS) Congress 2026; September 5-9, 2026; Barcelona, Spain.
