Population-based studies reveal that GLP-1 receptor agonists like semaglutide and liraglutide significantly reduce moderate and severe exacerbations in COPD and asthma patients with comorbid diabetes, particularly when compared to sulfonylureas and DPP-4 inhibitors. The protective effects appear strongest in obese patients with frequent exacerbations. This respiratory benefit operates through dual pathways: indirect metabolic improvements including weight loss and reduced systemic inflammation, plus direct actions on airway smooth muscle and immune cells expressing GLP-1 receptors. The finding represents a paradigm shift in respiratory medicine, suggesting that metabolic interventions can meaningfully impact lung disease outcomes beyond traditional bronchodilator approaches. While randomized cardiovascular trials showed neutral respiratory effects, this likely reflects inadequate outcome capture rather than absence of benefit. The consistency across diverse real-world datasets strengthens the signal, though observational studies carry inherent confounding risks. Recent proof-of-concept trials specifically designed for obesity-related lung disease are beginning to validate these observational findings. This positions GLP-1 agonists as potential systemic modulators for the growing population with overlapping metabolic and respiratory conditions.