Effect of bariatric surgery on lung function and asthma control after 8 years of follow-up

Abstract

Background: Bariatric surgery has a proven beneficial effect on asthma symptoms and lung function in patients with class III obesity and asthma. The effects of bariatric surgery on asthma control and small airway function persist for at least 12 months after bariatric surgery. However, long-term follow-up data are lacking. Objectives: To evaluate the very-long term effects of bariatric surgery on asthma symptoms and lung function. Methods: In a prospective, longitudinal follow-up study, we planned an 8-year follow-up visit for patients previously included in the OBAS 1.0 trial, which evaluated the effects of bariatric surgery on asthma control and lung function in patients with asthma and class III obesity in The Netherlands. Results: Fifteen of 78 patients from the OBAS trial completed the 8-year follow-up visit. Nine patients underwent bariatric surgery, and six patients did not. After 8 years of follow-up, asthma control (Asthma Control Questionnaire [ACQ] score at 12 months of 0,4 versus an ACQ score of 0.7 at 8 years of follow-up; p = 0.075) and small airway function (R5-R20 (frequency-dependent resistance at 5Hz-20Hz); score at 12 months of 0,25 versus an ACQ score of 0.07 at 8 years of follow-up; p = 0.345) remained clinically stable compared with 12 months of follow-up. Patients who underwent bariatric surgery had a statistically significant weight regain between 12 months of follow-up and 8 years of follow-up (median [interquartile range] body mass index 30.2 kg/m2 [23.9‐43.4 kg/m2] versus 32.3 kg/m2 [24.0‐36.4 kg/m2]; p = 0.025). However, the impact of weight regain on asthma control, and asthma quality of life was clinically insignificant (ACQ, β (regression coefficient) = 0.04; 95% Confidence Interval [0.02; 0.06]; p < 0.001; and AQLQ; β = ‐0.04 CI [‐0.07; ‐0.009]; p = 0.013). Conclusion: These results emphasize the importance of bariatric surgery in treating obesity-related asthma.

Obesity-related asthma: new insights leading to a different approach

“…Notably, apart from targeting inflammation, it is hypothesized that mepolizumab has a beneficial effect on small airways disease in severe asthmatic patients and this is currently being investigated in a cohort study (SASAM trial) [65]. As stated before, obesity is associated with small airways disease and it has been shown that weight reduction by bariatric surgery results in improvement in small airway function in asthmatic patients [20,66]. It is, therefore, interesting to investigate the potential role of biologics in improvement of small airways function in the obese asthmatic phenotype.…”

“…Bariatric surgery in morbidly obese asthmatic patients results in improved asthma control, quality of life, enhanced lung function, less bronchial hyperreactivity, and reduced medication use, leading to disease remission in some patients [69 ▪▪ ]. A recent study has demonstrated sustained improvements in lung function, asthma control, and small airway function in asthma patients 8 years after bariatric surgery [66]. A recent meta-analysis comparing surgical and nonsurgical weight loss interventions in obese asthma patients concluded that bariatric surgery resulted in greater weight loss and more consistent improvements in airway hyperresponsiveness, lung function, and medication use compared with nonsurgical weight loss interventions [70].…”

“…A recent study has demonstrated sustained improvements in lung function, asthma control, and small airway function in asthma patients 8 years after bariatric surgery [66]. A recent meta-analysis comparing surgical and nonsurgical weight loss interventions in obese asthma patients concluded that bariatric surgery resulted in greater weight and more consistent improvements in airway hyperresponsiveness, lung function, and medication use compared with nonsurgical weight loss interventions [70].…”