Skip to main content
SpringerLink
Log in

Asthma medication usage is significantly reduced following bariatric surgery

  • 2018 SAGES Oral
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Ogden CL, Carroll MD, Fryar CD, Flegal KM (2015) Prevalence of obesity among adults and youth: United States, 2011–2014. National Health and Nutrition Examination Survey. CDC 219:1–8

    Google Scholar 

  2. Peters-Golden M, Swern A, Bird SS, Hustard CM, Grant E, Edelman JM (2006) Influence of body mass index on the response to asthma controller agents. Eur Respir J 27(3):495–503

    Article  CAS  PubMed  Google Scholar 

  3. Beuther DA, Sutherland ER (2007) Overweight, obesity, and incident asthma: a meta-analysis of prospective epidemiologic studies. Am J Respir Crit Care Med 175(7):661–666

    Article  PubMed  PubMed Central  Google Scholar 

  4. Varraso R, Siroux V, Maccario J, Pin I, Kauffmann F, Epidemiological Study on the Genetics and Environment of Asthma (2005) Asthma severity is associated with body mass index and early menarche in women. Am J Respir Crit Care Med 171(4):334–339

    Article  PubMed  Google Scholar 

  5. Boulet LP (2008) Influence of obesity on the prevalence and clinical features of asthma. Clin Invest Med 31(6):386–390

    Article  Google Scholar 

  6. Engeland A, Bjørge T, Selmer RM, Tverdal A (2003) Height and body mass index in relation to total mortality. Epidemiology 14(3):293–299

    PubMed  Google Scholar 

  7. Heacock T, Lugogo N (2014) Role of weight management in asthma symptoms and control. Immunol Allergy Clin North Am 34(4):797–808

    Article  PubMed  Google Scholar 

  8. Haslam DW, James WP (2005) Obesity. Lancet 366(9492):1197–1209

    Article  PubMed  Google Scholar 

  9. Schatz M, Zeiger RS, Yang SJ, Chen W, Sajjan S, Allen-Ramey F, Camargo CA Jr (2015) Prospective study on the relationship of obesity to asthma impairment and risk. J Allergy Clin Immunol Pract 3(4):560–565

    Article  PubMed  Google Scholar 

  10. Camargo CA Jr, Weiss ST, Zhang S, Willett WC, Speizer FE (1999) Prospective study of body mass index, weight change, and risk of adult-onset asthma in women. Arch Intern Med 159(21):2582–2588

    Article  PubMed  Google Scholar 

  11. Haldar F, Pavord ID, Shaw DE, Berry MA, Thomas M, BrightliDng CE, Wardlaw AJ, Green RH (2008) Cluster analysis and clinical asthma phenotypes. Am J Respir Crit Care Med 178(3):218–224

    Article  PubMed  Google Scholar 

  12. Moore WC, Meyers DA, Wenzel SE, Teague WG, Li H, Li X, D’Agostino R Jr, Castro M, Curran-Everett D, Fitzpatrick AM, Gaston B, Jarjour NN, Sorkness R, Calhoun WJ, Chung KF, Comhair SA, Dweik RA, Israel E, Peters SP, Busse WW, Erzurum SC, Bleecker ER (2010) National heart lung and blood institute’s severe asthma research program. Am J Respir Crit Care Med 181(4):315–323

    Article  PubMed  Google Scholar 

  13. Sturm R, An R (2014) Obesity and economic environments. CA Cancer J Clin 64(5):337–350

    Article  PubMed  PubMed Central  Google Scholar 

  14. Pakhale S, Baron J, Dent R, Vandemheen K, Aaron SD (2015) Effects of weight loss on airway responsiveness in obese adults with asthma: does weight loss lead to reversibility of asthma? Chest 147(6):1582–1590

    Article  PubMed  Google Scholar 

  15. Sikka N, Wegienka G, Havstad S, Genaw J, Carlin AM, Zoratti E (2010) Respiratory medication prescriptions before and after bariatric surgery. Ann Allergy Asthma Immunol 104(4):326–330

    Article  PubMed  Google Scholar 

  16. Angrisani L, Santonicola A, Iovino P, Vitello A, Zundel N, Buchwald H, Scopinaro N (2017) Bariatric surgery and endoluminal procedures: IFSO Worldwide survey 2014. Obes Surg 27(9):2290–2292

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Sjostrom L (2008) Bariatric surgery and reduction in morbidity and mortality: experiences from the SOS study. Int J Obes 32(7):93–97

    Article  Google Scholar 

  18. Scott HA, Wood LG, Gibson PG (2017) Role of obesity in asthma: mechanisms and management strategies. Curr Allergy Asthma Rep 17(8):53

    Article  PubMed  Google Scholar 

  19. Hewitt S, Humerfelt S, Søvik TT, Aasheim ET, Risstad H, Kristinsson J, Mala T (2014) Long-term improvements in pulmonary function 5 years after bariatric surgery. Obes Surg 24(5):705–711

    Article  PubMed  Google Scholar 

  20. Nguyen NT, Hinojosa MW, Smith BR, Gray J, Varela E (2009) Improvement of restrictive and obstructive pulmonary mechanics following laparoscopic bariatric surgery. Surg Endosc 23(4):808–812

    Article  PubMed  Google Scholar 

  21. van Huisstede A, Rudolphus A, Castro Cabezas M, Biter LU, van de Geijn GJ, Taube C, Hiemstra PS, Braunstahl GJ (2015) Effect of bariatric surgery on asthma control, lung function and bronchial and systemic inflammation in morbidily obese subjects with asthma. Thorax 70(7):659–667

    Article  PubMed  Google Scholar 

  22. National Asthma in Education and Prevention Program (2007) Expert panel report 3 (EPR-3): guidelines for the diagnosis and management of asthma—summary report 2007. J Allergy Clin Immunol 120(5):94–138

    Article  Google Scholar 

  23. Katz PO, Gerson LB, Vela MF (2013) Guidelines for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol 108:308–328

    Article  PubMed  Google Scholar 

  24. James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, Lackland DT, LeFevre ML, MacKenzie TD, Ogedegbe O, Smith SC, Svetkey LP, Taler SJ, Townsend RR, Wright JT, Narva AS, Ortiz E (2014) 2014 evidence-based guideline for the management of high blood pressure in adults. JAMA 311(5):507–520

    Article  CAS  PubMed  Google Scholar 

  25. Hampton T (2014) Studies probe links between childhood asthma and obesity. JAMA 311:1718–1719

    Article  PubMed  Google Scholar 

  26. Al-Alwan A, Bates JH, Chapman DG, Kamisnsky DA, DeSarno MJ, Irvin CG, Dixon AE (2014) The nonallergic asthma of obesity a matter of distal lung compliance. Am J Respir Crit Care Med 189(12):1494–1502

    Article  PubMed  PubMed Central  Google Scholar 

  27. Umetsu DT (2017) Mechanism by which obesity impacts upon asthma. Thorax 72(2):174–177

    Article  PubMed  Google Scholar 

  28. Bildstrup L, Backer V, Thomsen SF (2015) Increased body mass index predicts severity of asthma symptoms but not objective asthma traits in a large sample of asthmatics. J Ashtma 52(7):687–692

    Google Scholar 

  29. Dixon AE, Holquin F, Sood A, Salome CM, Pratley RE, Beuther DA, Celedon JC, Shore SA, American Thoracic Society Ad Hoc Subcommittee on Obesity and Lung Disease (2010) An official american thoracic society workshop report: obesity and asthma. Proc Am Thorac Soc 7(5):325–335

    Article  PubMed  Google Scholar 

  30. Mohanan S, Tapp H, McWilliams A, Dulin M (2014) Obesity and asthma: pathophyisiology and implications for diagnosis and management in primary care. Exp Biol Med 239(11):1531–1540

    Article  CAS  Google Scholar 

  31. Mukadam S, Zacharias J, Henao MP, Kraschnewski J, Ishmael F (2017) Differential effects of obesity on eosinophilic vs. non-eosinophilic asthma subtypes. J Asthma 28:1–6

    Google Scholar 

  32. Gibeon D, Batuwita K, Osmond M, Heany LG, Brightling CE, Niven R, Mansur A, Chaudhuri R, Bucknall CE, Rowe A, Guo Y, Bhavsar PK, Chung KF, Menzies-Gow A (2013) Obesity-associated severe asthma represents a distinct clinical phenotype: analysis of the british thoracic society difficult asthma registry patient cohort according to BMI. Chest 143(2):406–414

    Article  CAS  PubMed  Google Scholar 

  33. Gupta S, Lodha R, Kabra SK (2017) Asthma, GERD and obesity: triangle of inflammation. Indian J Pediatr. https://doi.org/10.1007/s12098-017-2484-0

    Article  PubMed  Google Scholar 

  34. Priyadarshini P, Singh VP, Aggarwal S, Garg H, Sinha S, Guleria R (2017) Impact of bariatric surgery on obstructive sleep apnoea-hypopnea syndrome in morbidly obese patients. J Minim Acces Surg 13(4):291–295

    Article  Google Scholar 

  35. Hariri K, Kini SU, Herron DM, Fernandez-Ranvier G (2017) Resolution of symptomatic obstructive sleep apnea not impacted by preoperative body mass index, choice of operation between sleeve gastrectomy and Roux-en-Y gastric bypass surgery, or severity. Obes Surg. https://doi.org/10.1007/s11695-017-3042-6

    Article  Google Scholar 

  36. Reddy RC, Baptist AP, Fan Z, Carlin AM, Birkmeyer NJ (2011) The effects of bariatric surgery on asthma severity. Obes Surg 21(2):200–206

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors would like to thank Dr. Loretta Que and Mr. James Alexander for their contributions to this study.

Author information

Authors and Affiliations

  1. Department of Surgery, Division of Metabolic and Weight Loss Surgery, Duke University Health System, 407 Crutchfield St, Durham, NC, 27704, USA

    Alfredo D. Guerron, Camila B. Ortega, Gerardo Davalos & Dana Portenier

  2. Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, USA

    Hui-Jie Lee

  3. Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Duke University Health System, Durham, NC, USA

    Jennifer Ingram

Authors
  1. Alfredo D. Guerron
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Camila B. Ortega
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hui-Jie Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Gerardo Davalos
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jennifer Ingram
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Dana Portenier
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alfredo D. Guerron.

Ethics declarations

Disclosures

Daniel Guerron is a consultant and speaker for Levita and Mederi and a speaker for Medtronic and Gore. Camila Ortega, Hui-Jie Lee, and Gerardo Davalos have nothing to disclose. Jennifer Ingram has the following funding from the National Institutes of Health: NIH/NHLBI 1R01HL130234-01A1 and no other disclosures to report. Dana Portenier is a consultant for Medtronic/Covidien, Teleflex, Allergan, Gore, and Intuitive. Additionally he holds a grant from Teleflex. Research reported in this publication was supported by the National Center For Advancing Translational Sciences of the National Institutes of Health under Award Number UL1TR002553. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Guerron, A.D., Ortega, C.B., Lee, HJ. et al. Asthma medication usage is significantly reduced following bariatric surgery. Surg Endosc 33, 1967–1975 (2019). https://doi.org/10.1007/s00464-018-6500-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-018-6500-x

Keywords

Search

Navigation