PURPOSE: Evaluate the impact of bariatric surgery on five morbidly obese severe asthmatics.
METHODS: Retrospective review of asthma charts.
RESULTS: All five patients had asthma prior to becoming obese, with multiple sensitivities and bronchodilator responsiveness. Three had severe persistent and two had moderate persistent asthma. All required ICS/LABA, leukotriene antagonists, frequent daily albuterol. Two were steroid dependent. All had concomitant GERD, OSA, DM. Mean BMI pre-op 50.26, post-op 30.74. Average PFT improvements were FEV1 13% (p=.058), FVC 11% (p=.02) , TLC 27% (p=.0015). Excellent asthma control was achieved in four patients and moderate control in one with a mean asthma control index of 23.4. Two required only prn albuterol over the 7 and 4 years since surgery. One is asymptomatic on daily montelukast alone (6 years) and two required ICS and montelukast, one with rare albuterol (5 years), and one with albuterol several times per week (7 years). The patient well-controlled on fluticasone and singulair had been the most severe, with five hospitalizations the year before surgery and continuous prednisone. She is currently asymptomatic, no prednisone or hospitalizations. Nonetheless she showed no change in FEV1. Four have not had any hospitalizations or ER visits for asthma. The fifth patient has had a significant decrease in her hospitalizations from six to one per year and from 10 to two ER visits per year. All had resolution of DM, sleep apnea, and restoration of exercise tolerance (ET).
CONCLUSION: Weight loss through bariatric surgery results in improved asthma control even for serious asthmatics. Not all the improvement in asthma control is explained by the improvement in mechanics alone because the most striking improvement occurred in the patient with no change in FEV1.
CLINICAL IMPLICATIONS: The interaction of serious asthma, steroids, and decreased ET results in a cycle of weight gain, diabetes, sleep apnea, and GERD, and further deterioration of asthma control and overall health. Weight loss through bariatric surgery interrupts this cascade with significant improvement and sometimes complete resolution of asthma symptoms.
DISCLOSURE: Mary O'Sullivan, No Financial Disclosure Information; No Product/Research Disclosure Information