Can GLP-1s improve COPD symptoms? Experts weigh in
Key Takeaways
GLP-1s hold promise in the treatment of COPD by addressing systemic inflammation, oxidative stress, and airway remodeling.
These effects are found to be useful in COPD with comorbidities like diabetes, obesity, and cardiovascular dysfunction.
While early data is encouraging, these drugs remain unapproved for COPD, and more evidence is needed before they become a standard part of care.
Chronic obstructive pulmonary disease (COPD) is a tough condition to manage, especially when it’s complicated by comorbidities like diabetes, obesity, or heart disease. Recent interest has grown around the potential role of GLP-1 receptor agonists (GLP-1RAs)—drugs used primarily for glycemic control and weight loss—in COPD management. These drugs have demonstrated anti-inflammatory and metabolic benefits, which might help COPD patients.
"There’s some exciting preliminary data. We’ve seen better lung function and fewer exacerbations in patients using GLP-1RAs, [but] we still need larger, well-designed trials."
— Alok Mohta, MD, MBBS
The COPD-diabetes link
COPD and diabetes often occur together, with up to 25% of COPD patients having diabetes.[] "Hyperglycemia accelerates oxidative stress, worsens systemic inflammation, and further impairs lung function," says Alok Mohta, MD, MBBS, a board-certified physician with over 30 years of experience treating COPD.
"It’s a double hit for these patients. You’ve got to manage both diseases aggressively and simultaneously since uncontrolled type 2 diabetes can exacerbate COPD, increasing the frequency of exacerbations and hospitalizations,” Dr. Mohta explains.
What GLP-1s can do
Michael Lahey, MD, a board-certified physician trained in pulmonary medicine, confirms that GLP-1s can be effective for COPD management. "Apart from the fact that GLP-1 inhibitors are antidiabetic reagents that have been known to help regulate blood sugar levels, preliminary research brings to light the possibility of their use in COPD treatment," he says.
"Several research works have examined the glucoregulatory, anti-inflammatory, and bronchodilator activities of GLP-1 receptor agonists and pointed to their efficacy in decreasing airway inflammation and pulmonary function in COPD sufferers," Dr. Lahey says.
However, Michael O. McKinney, MD, a board-certified physician with a focus on respiratory diseases adds, “Further clinical trials that are more comprehensive are required to prove how GLP-1 inhibitors can affect some symptoms of COPD-relevant clinical episodes.”
"These drugs not only help in weight reduction but also reduce systemic inflammation and improve metabolic profiles that are needed in the treatment of COPD."
— Michael O. McKinney, MD
Additionally, John Lowe, MD, a board-certified physician at Restore Care in Utah, adds that, "Given that systemic inflammation is remediated and insulin sensitivity is enhanced, there is plausible justification for the positiveness of GLP-1s on lung health, especially in patients with COPD and comorbid obesity or diabetes."
Emerging research suggests that GLP-1RAs like semaglutide, liraglutide, and dulaglutide have anti-inflammatory effects in COPD patients; consider the following:
A 2022 population-based cohort study found a 30% reduction in moderate and severe COPD exacerbations with GLP-1RAs compared to sulfonylureas.[]
Another study, published in the International Journal of Chronic Obstructive Pulmonary Disease, reported improvements in forced vital capacity, carbon monoxide diffusion, and COPD assessment scores after 40 weeks of liraglutide treatment in obese patients.[]
In animal models, GLP-1RAs also showed immunomodulatory effects, reducing lung inflammation and improving pulmonary function in obstructive lung diseases.[]
“The fact that GLP-1RAs reduce markers of systemic inflammation such as TNF-α and IL-6 in diabetic patients suggests they could have similar effects on the chronic inflammation seen in COPD,” adds Dr. Mohta.
Targeting oxidative stress
Oxidative stress plays a major role in COPD’s progression.[] Smoking and environmental pollution cause an overproduction of reactive oxygen species (ROS), which damages lung tissue and impairs lung function. Interestingly, GLP-1RAs reduce oxidative stress in diabetic patients, and emerging data suggests they could have similar effects in COPD.
"GLP-1RAs could reduce mitochondrial dysfunction and ROS production, which might slow down the destruction of lung tissue, reducing disease progression and improving long-term outcomes for COPD patients,” says Dr. Mohta.
Airway remodeling
Airway remodeling, driven by chronic inflammation and fibrosis, is one of the hallmarks of COPD. There’s hope that GLP-1RAs, with their anti-inflammatory properties, might help mitigate this airway damage.
"GLP-1 receptors are found in lung tissue, which means these drugs could have direct effects on the airways," Dr. Mohta points out. "There’s evidence that GLP-1RAs can reduce fibrosis and smooth muscle cell proliferation—both big players in COPD’s progression."
Improving cardiac function
Patients with COPD often face a higher risk of cardiovascular diseases due to chronic inflammation, smoking, other comorbidities, and the side effects of treatments. “Inhaled steroids, beta-2 agonists, and systemic corticosteroids can raise heart risks by affecting heart rate, blood pressure, and blood sugar, with type 2 diabetes further increasing these risks,” says Dr. Mohta.
A 2024 study in Chest explored the impact of GLP-1RA and GIP/GLP-1 co-agonists on heart health in COPD patients with type 2 diabetes.[] The study found a 15% reduction in major adverse cardiovascular events (MACE), such as heart failure, heart attacks, and cardiac arrest, in patients receiving these treatments. Additionally, there was a 41% reduction in all-cause mortality in these cases.
While the potential for GLP-1RAs in COPD treatment is intriguing, more research is needed to confirm their benefits. Right now, these drugs are not approved for COPD, and large-scale, targeted clinical trials are required.
"The mechanistic rationale is strong—anti-inflammatory, anti-oxidative, and potential airway protection—but we need real clinical outcomes to back this up."
— Alok Mohta, MD, MBBS
"If we can validate these benefits, GLP-1RAs could become an important tool for managing COPD, especially in patients who also have diabetes or cardiovascular illnesses,” Dr. Mohta concludes.
What this means for you
The future of COPD treatment might involve a combination of both pharmacological and non-pharmacological therapies, with GLP-1RAs being a potential option for managing inflammation and oxidative stress in patients with comorbid diabetes or obesity.