Asthma medication usage is significantly reduced following bariatric surgery

Abstract

Introduction Asthma is an important healthcare problem affecting millions in the United States. Additionally, a large proportion of patients with asthma suffer from obesity. These patients exhibit poor asthma control and reduced therapy response, increasing utilization of healthcare resources. Pulmonary symptoms improve after bariatric surgery (BS), and we hypothesized that asthma medication usage would decrease following BS. Methods A retrospective data analysis was performed in adult patients from a single institution’s database. Patients with obesity using at least one asthma medication pre-operatively who underwent BS were studied for up to 3-years post-operation. Poisson generalized linear mixed models for repeated measures were used to evaluate the effects of time and procedure type on the number of asthma medication. Results Bariatric patients with at least one prescribed asthma medication (mean 1.4 ± 0.6) were included (n = 751). The mean age at time of operation was 46.8 ± 11.6 years, mean weight was 295.9 ± 57 lbs, and mean body mass index (BMI) was 49 ± 8.2 kg/m2; 87.7% were female, 33.4% had diabetes, 44.2% used gastroesophageal reflux disease (GERD) medication, and 64.4% used hypertension medication. The most common procedure was Roux-en-Y gastric bypass (79%), followed by sleeve gastrectomy (10.7%), adjustable gastric banding (8.1%), and duodenal switch (2.3%). The mean number of prescribed asthma medications among all procedures decreased by 27% at 30 days post-operation (p < 0.0001), 37% at 6 months (p < 0.0001), 44% at 1 year (p < 0.0001), and 46% at 3 years (p < 0.0001) after adjusting for risk factors. No significant differences in medication use over time between procedure types were observed. In the adjusted analysis, the mean number of asthma medications was 12% higher in patients using at least one GERD medication (p = 0.015) and 8% higher with 10-unit increase in pre-operative BMI (p = 0.006). Conclusion BS significantly decreases asthma medication use starting 30 days post-operation with a sustained reduction for up to 3 years.

The Gut/Lung Microbiome Axis in Obesity, Asthma, and Bariatric Surgery: A Literature Review

“…There is a clear need for more studies that consider the effect of a restrictive diet before surgery if one was employed. Finally, despite growing evidence that bariatric surgery could be beneficial for patients with asthma (7,9,92,93), to the best of our knowledge, no study has explored whether the airway/lung microbiome changes after bariatric surgery.…”

“…At present, some postsurgical changes in the gut microbiome are correlated with parameters of metabolic syndrome. Furthermore, reduced asthma medication usage (93) and gut microbiome alterations were reported as early as 30 days following surgery (74), which is likely too soon for weight loss to have a large impact. Therefore, a central question is whether this improvement in asthma control is because of metabolic changes and whether these changes are caused by microbiome alterations.…”

“…Bariatric surgery is associated with improvements in asthma control (7,93,94) and in AHR (7), although this protective effect was not observed in patients with metabolic syndrome (95). Provided with the relationships between the airway and gut microbiomes with obesity, asthma, and bariatric surgery as presented in Figure 2, we questioned whether the microbiomes contribute to bariatric-surgery-associated protection against asthma.…”

Laparoscopic Sleeve Gastrectomy: Outcomes, Safety and Complications

“…Asthma medication usage was also reduced following LSG [30]. A retrospective analysis of 751 asthmatic patients, including 80 LSG patients, found that the number of prescribed asthma medications among all procedures significantly decreased by 27% at 30 days post-surgery, 37% at 6 months, 44% at 1 year, and 46% at 3 years [30].…”

Racial Disparities in Bariatric Surgery Complications and Mortality Using the MBSAQIP Data Registry

“…Similar trends are found among men. Weight loss surgery remains the most effective treatment for moderate to severe obesity and resolution of obesity-related comorbidities [2][3][4][5][6][7]. Most bariatric operations have very low rates of morbidity and mortality [8] and are among the more commonly performed operations in the USA [9].…”