Higher triglyceride-glucose index and lower type 2 inflammation are associated with increased risk of asthma exacerbations: a prospective cohort study

<bold>Background:</bold> The triglyceride-glucose (TyG) index, a novel marker for metabolic dysfunction, has recently been associated with lung health. However, the intricate relationship among the TyG index, type 2 (T2) inflammation, and asthma remains largely unexplored. <bold>Aims:</bold> To explore the associations of TyG index, T2 inflammation and the risk of asthma exacerbations. <bold>Methods:</bold> This study was a prospective cohort study based on the Australasian Severe Asthma Network. Stable asthma patients were divided into four groups by the TyG index and T2 status. The clinical characteristics and inflammatory features of asthma were compared across these groups. Adjusted incidence rate ratios (aIRRs) were used to examine the relationship among TyG index, T2 inflammation and asthma exacerbations. <bold>Results:</bold> Four groups were TyG^lowT2^high (n = 277), TyG^lowT2^low (n = 193), TyG^highT2^high (n = 84) and TyG^highT2^low (n = 72). TyG^highT2^high and TyG^highT2^low groups had elevated obesity status and metabolic dysfunction, and worse lung function than TyG^lowT2^high and TyG^lowT2^low groups. TyG^highT2^high and TyG^lowT2^high groups had increased eosinophils, IgE and FeNO, but less neutrophils than TyG^highT2^low and TyG^lowT2^low groups. Furthermore, compared with the TyG^lowT2^high group, TyG^highT2^low group were at significantly increased risk of moderate-to-severe exacerbations (aIRR=2.54, 95%CI=[1.56, 4.15]), severe exacerbations (aIRR=2.72, 95%CI=[1.29, 5.76]), emergency visits (aIRR=7.88, 95%CI=[2.71, 22.92]) and unscheduled visits (aIRR=2.87, 95%CI=[1.65, 4.98]). <bold>Conclusion:</bold> Assessing the TyG index and T2 status simultaneously is important in the management of asthma.