Metabolic-Driven Asthma: Weight-Loss and Metabolic Interventions as a Therapeutic Lever

Obesity and metabolic dysfunction are now recognized as major drivers of a distinct, difficult-to-treat asthma phenotype, marked by reduced lung volumes, elevated systemic inflammation, blunted response to inhaled corticosteroids and often non-eosinophilic airway inflammation. Over the past decade, a substantial body of epidemiological work has established the associations between excess adiposity and insulin resistance, and worse asthma control, increased exacerbation frequency, and poorer quality of life. However, this evidence has largely stopped at description: it maps the link between metabolic dysfunction and asthma burden without offering an actionable framework for intervention.This gap is increasingly being closed. The past two years have seen a marked rise in clinical and translational research evaluating metabolic interventions as direct therapeutic strategies for asthma, rather than as incidental comorbidity management. GLP-1 receptor agonists and dual incretin therapies, originally developed for type 2 diabetes and obesity, are now being studied for their independent anti-inflammatory and airway effects. Bariatric and metabolic surgery cohorts are being followed for changes in airway hyperresponsiveness, lung mechanics, and long-term medication burden. Structured weight-loss and lifestyle programs are being tested not just for weight-related outcomes but for their downstream effects on exacerbation rates and biologic responsiveness. At the same time, mechanistic and translational studies are beginning to clarify how adipose-tissue-derived signaling, systemic inflammation, and immunometabolic pathways connect weight change to airway outcomes.Despite this momentum, the field lacks a consolidated, cross-regional evidence base connecting metabolic interventions directly to respiratory outcomes. Much of the available literature remains fragmented across endocrinology, bariatric surgery, and respiratory medicine, with limited synthesis of how these interventions interact with existing asthma treatment pathways, including biologic therapies.This Research Topic aims to consolidate and advance the interventional evidence base for metabolic-driven asthma, focusing on weight-loss strategies and metabolic treatments as active therapeutic levers rather than passive risk-factor modifiers. We welcome contributions examining the direct, measurable effects of these interventions on asthma control, exacerbation rates, lung function, and biologic response, drawn from clinical, real-world, and mechanistic research.We welcome articles addressing, but not limited to, the following themes:- Efficacy and real-world outcomes of GLP-1 receptor agonists and dual incretin therapies on asthma control and exacerbation frequency- Bariatric and metabolic surgery outcomes on airway hyperresponsiveness, lung mechanics, and medication reduction- Effects of metabolic and weight-loss interventions on responsiveness to biologic therapies (anti-IL-5/5R, anti-IL-4Rα, anti-TSLP) in obesity-associated asthma- Structured lifestyle, nutritional, and exercise intervention programs and their impact on asthma control and systemic inflammatory markers- Mechanistic and translational pathways linking metabolic treatment to airway inflammation, remodeling, and immune signaling- Identification of clinical and biomarker predictors of respiratory response to metabolic interventionAll article types are accepted, including Original Research, Review, FAIR² Data Article, Brief Research Report, Mini Review, and Perspective articles. Topic editors: Douglas Cowan, Yang Xie Source: https://www.frontiersin.org/research-topics/84961/metabolic-driven-asthma-weight-loss-and-metabolic-interventions-as-a-therapeutic-lever