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Obesity Surgery

, Volume 24, Issue 5, pp 705–711 | Cite as

Long-Term Improvements in Pulmonary Function 5 Years After Bariatric Surgery

  • Stephen HewittEmail author
  • Sjur Humerfelt
  • Torgeir T. Søvik
  • Erlend T Aasheim
  • Hilde Risstad
  • Jon Kristinsson
  • Tom Mala
Original Contributions

Abstract

Background

Obesity is associated with reduced pulmonary function. We evaluated pulmonary function and status of asthma and obstructive sleep apnoea syndrome (OSAS) before and 5 years after bariatric surgery.

Methods

Spirometry was performed at baseline and 5 years postoperatively. Information of asthma and OSAS were recorded. Of 113 patients included, 101 had undergone gastric bypass, 10 duodenal switch and 2 sleeve gastrectomy.

Results

Eighty (71 %) patients were women, mean preoperative age was 40 years and preoperative weight was 133 kg in women and 158 kg in men. Five years postoperatively, weight reduction was 31 % (42 kg; p < 0.001) in women and 24 % (38 kg; p < 0.001) in men. Forced expiratory volume in 1 s (FEV1) increased 4.1 % (116 ml; p < 0.001) in women and 6.7 % (238 ml; p = 0.003) in men. Forced vital capacity (FVC) increased 5.8 % (209 ml; p < 0.001) in women and 7.6 % (349 ml; p < 0.001) in men. Gender and weight loss were independently associated with the improvements in FEV1 and FVC. At follow-up, FEV1 had increased 36 % of the difference towards the estimated normal FEV1, and there was a corresponding 70 % recovery of FVC. These improvements occurred despite an expected decline in pulmonary function by age during the study period. Of the asthmatics and OSAS patients, 48 and 80 %, respectively, were without symptoms 5 years postoperatively.

Conclusions

Pulmonary function measured with spirometry was significantly improved 5 years after bariatric surgery, despite an expected age-related decline during this period. Symptoms of asthma and OSAS also improved.

Keywords

Bariatric surgery Gastric bypass Obesity Weight loss Pulmonary function FEV1 FVC Spirometry Asthma Obstructive sleep apnoea 

Notes

Conflict of Interest

Jon Kristinsson and Tom Mala received travel support via payments to their institution, given by Covidien and Ethicon Endo-Surgery. Stephen Hewitt, Sjur Humerfelt, Torgeir T Søvik, Erlend T Aasheim and Hilde Risstad did not report any disclosures.

References

  1. 1.
    James PT. Obesity: the worldwide epidemic. Clin Dermatol. 2004;22:276–80.PubMedCrossRefGoogle Scholar
  2. 2.
    Anderssen SA, Engeland A, Søgaard AJ, et al. Changes in physical activity behavior and the development of body mass index during the last 30 years in Norway. Scand J Med Sci Sports. 2008;18:3009–317.CrossRefGoogle Scholar
  3. 3.
    Engeland A, Bjørge T, Selmer RM, et al. Height and body mass index in relation to total mortality. Epidemiology. 2003;14:293–9.PubMedGoogle Scholar
  4. 4.
    Murugan AT, Sharma G. Obesity and respiratory diseases. Chron Respir Dis. 2008;5(4):233–42.PubMedCrossRefGoogle Scholar
  5. 5.
    Rabec C, de Lucas RP, Veale D. Respiratory complications of obesity. Arch Broncopneumol. 2011;47(5):252–61.CrossRefGoogle Scholar
  6. 6.
    Haslam DW, James WP. Obesity. Lancet. 2005;366:1197–209.PubMedCrossRefGoogle Scholar
  7. 7.
    Littleton SW. Impact of obesity on respiratory function. Respirology. 2012;17:43–9.PubMedCrossRefGoogle Scholar
  8. 8.
    Carey IM, Cook DG, Strachan DP. The effects of adiposity and weight change on forced expiratory volume decline in a longitudinal study of adults. Int J Obes. 1999;23:979–85.CrossRefGoogle Scholar
  9. 9.
    Thyagarajan B, Jacobs DR, Apostol GG, et al. Longitudinal association of body mass index with lung function: The CARDIA Study. Respir Res. 2008;9:31–40.PubMedCentralPubMedCrossRefGoogle Scholar
  10. 10.
    Steele RM, Finucane FM, Griffin SJ, et al. Obesity is associated with altered lung function independently of physical activity and fitness. Obesity. 2008;17:578–84.PubMedCrossRefGoogle Scholar
  11. 11.
    Juel CT, Ali Z, Nilas L, et al. Asthma and obesity: does weight loss improve asthma control? A systematic review. J Asthma Allergy. 2012;5:21–6.PubMedCentralPubMedGoogle Scholar
  12. 12.
    Stenius-Aarniala B, Poussa T, Kvarnström J, et al. Immediate and long term effects of weight reduction in obese people with asthma: randomised controlled study. BMJ. 2000;320:827–32.PubMedCentralPubMedCrossRefGoogle Scholar
  13. 13.
    Lagerstrand L, Rössner S. Effects of weight loss on pulmonary function in obese men with obstructive sleep apnoea syndrome. J Intern Med. 1993;234:245–7.CrossRefGoogle Scholar
  14. 14.
    Olsén MF, Wiklund M, Lönroth H, et al. Respiratory function in superobese patients before and after bariatric surgery—a randomised controlled trial. Open Obes J. 2012;4:28–34.CrossRefGoogle Scholar
  15. 15.
    Nguyen NT, Hinojosa MW, Smith BR, et al. Improvement of restrictive and obstructive pulmonary mechanics following laparoscopic bariatric surgery. Surg Endosc. 2009;23:808–12.PubMedCrossRefGoogle Scholar
  16. 16.
    de Souza SAF, Faintuch J, Cecconello I. Spirometric function improves in the morbidly obese after 1-year post-surgery. Obes Surg. 2010;20:1273–7.PubMedCrossRefGoogle Scholar
  17. 17.
    Santana ANC, Souza R, Martins AP, et al. The effect of massive weight loss on pulmonary function of morbid obese patients. Respir Med. 2006;100:1100–4.PubMedCrossRefGoogle Scholar
  18. 18.
    Davila-Cervantes A, Dominguez-Cherit G, Borunda D, et al. Impact of surgically-induced weight loss on respiratory function: a prospective analysis. Obes Surg. 2004;14:1389–92.PubMedCrossRefGoogle Scholar
  19. 19.
    Sjöstrøm L. Bariatric surgery and reduction in morbidity and mortality: experiences from the SOS study. Int J Obes. 2008 Dec;32(S7):S93–7.Google Scholar
  20. 20.
    Anonymous. Gastrointestinal surgery for severe obesity: National Institutes of Health Consensus Development Conference Statement. Am J Clin Nutr. 1992;55:615S–9S.Google Scholar
  21. 21.
    Søvik TT, Taha O, Aasheim ET, et al. Randomized clinical trial of laparoscopic gastric bypass versus laparoscopic duodenal switch for superobesity. Br J Surg. 2010;97(2):160–6.PubMedCrossRefGoogle Scholar
  22. 22.
    American Thoracic Society. Standardization of spirometry, 1994 update. Am J Respir Crit Care Med. 1995 Sep;152(3):1107–36.Google Scholar
  23. 23.
    Gulsvik A, Tosteson T, Bakke P, et al. Expiratory and inspiratory forced vital capacity and one-second forced volume in asymptomatic never-smokers in Norway. Clin Physiol. 2001;21:648–60.PubMedCrossRefGoogle Scholar
  24. 24.
    Aftab H, Risstad H, Søvik TT, Bernklev T, Hewitt S, Kristinsson J, et al. Five-year outcome after gastric bypass for morbid obesity in a Norwegian cohort. Surg Obes Relat Dis. 2013. doi:10.1016/j.soard.2013.05.003
  25. 25.
    Hewitt S, Søvik TT, Aasheim ET, et al. Secondary hyperparathyroidism, vitamin D sufficiency, and serum calcium 5 years after gastric bypass and duodenal switch. Obes Surg. 2013;23(3):384–90.PubMedCrossRefGoogle Scholar
  26. 26.
    Wei Y-F, Wu H-D. Candidates for bariatric surgery: morbidly obese patients with pulmonary dysfunction. Journal of Obesity 2012; article ID 87837: 1–6. doi:101155/2012/878371.Google Scholar
  27. 27.
    From the global strategy for asthma management and prevention, Global Initiative for Asthma (GINA) 2012. http://www.ginasthma.org/. Accessed 2 Jan 2014.
  28. 28.
    Hakala K, Stenius-Aarniala B, Sovijarvi A. Effects of weight loss on peak flow variability, airways obstruction, and lung volumes in obese patients with asthma. Chest. 2000;118(5):1315–21.PubMedCrossRefGoogle Scholar
  29. 29.
    Reddy RC, Baptist AP, Fan Z, et al. The effects of bariatric surgery on asthma severity. Obes Surg. 2011;21:200–6.PubMedCrossRefGoogle Scholar
  30. 30.
    Lettieri CJ, Eliasson AH, Greenburg DL. Persistence of obstructive sleep apnoea after surgical weight loss. J Clin Sleep Med. 2008;4(4):333–38.PubMedCentralPubMedGoogle Scholar
  31. 31.
    Dixon JB, Schachter LM, O'Brian PE, et al. Surgical vs conventional therapy for weight loss treatment of obstructive sleep apnoea. A randomized controlled trial. JAMA. 2012;308(11):1142–49.PubMedCrossRefGoogle Scholar
  32. 32.
    Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery. A systematic review and meta-analysis. JAMA. 2004;292(14):1724–37.PubMedCrossRefGoogle Scholar
  33. 33.
    Eneli IU, Skybo T, Camargo Jr CA. Weight loss and asthma: a systematic review. Thorax. 2008;63:671–76.PubMedCrossRefGoogle Scholar
  34. 34.
    Sutherland ER. Obesity and asthma. Immunol Allergy Clin North Am. 2008;28(3):589–602.PubMedCentralPubMedCrossRefGoogle Scholar
  35. 35.
    Laurino Neto RM, Herbella FAM, Tauil RM, et al. Comorbidities remission after Roux-en-Y gastric bypass for morbid obesity is sustained in a long-term follow-up and correlates with weight regain. Obes Surg. 2012;22:1580–85.PubMedCrossRefGoogle Scholar
  36. 36.
    Akinnusi ME, Saliba R, Porhomayon J, et al. Sleep disorders in morbid obesity. Eur J Int Med. 2012;23:219–26.CrossRefGoogle Scholar
  37. 37.
    Greenburg DL, Lettieri CJ, Eiasson AH. Effects of surgical weight loss on measures of obstructive sleep apnoea: a meta-analysis. Am J Med. 2009;122:535–42.PubMedCrossRefGoogle Scholar
  38. 38.
    Harper J, Madan AK, Ternovits CA, et al. What happens to patients who do not follow-up after bariatric surgery? Am Surg. 2007;73:181–4.PubMedGoogle Scholar
  39. 39.
    Beuther DA, Sutherland ER. Overweight, obesity, and incident asthma. A meta-analysis of prospective epidemiologic studies. Am J Respir Crit Care Med. 2007;175:661–66.PubMedCentralPubMedCrossRefGoogle Scholar
  40. 40.
    van Huisstede A, Cabezas MC, van de Geijn G-JM, et al. Underdiagnosis and overdiagnosis of asthma in the morbidly obese. Respir Med. 2013. doi: 10.1016/j.rmed.2013.05.007.PubMedGoogle Scholar
  41. 41.
    Nystad W, Magnus P, Søyseth V. Occurrence of asthma among school children in Norway during the period 1985–94. Tidsskr Nor Laegeforen. 1997;117:644–47.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Stephen Hewitt
    • 1
    Email author
  • Sjur Humerfelt
    • 2
  • Torgeir T. Søvik
    • 3
  • Erlend T Aasheim
    • 1
  • Hilde Risstad
    • 1
  • Jon Kristinsson
    • 1
  • Tom Mala
    • 1
    • 3
  1. 1.Department of Morbid Obesity and Bariatric Surgery, Department of Endocrinology, Obesity and Preventive Medicine, Medical ClinicOslo University Hospital, AkerOsloNorway
  2. 2.Department of Pulmonary Medicine, Medical ClinicOslo University Hospital, AkerOsloNorway
  3. 3.Department of Gastrointestinal Surgery, Clinic of Surgery, Medical ClinicOslo University Hospital, Aker/UllevålOsloNorway

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