Effect of bariatric surgery on asthma control, lung function and bronchial and systemic inflammation in morbidly obese subjects with asthma

BackgroundThe pathogenesis of asthma in obese subjects is poorly understood and has been described as a specific phenotype in these patients. Weight loss improves asthma control and lung function. Whether this improvement is the result of better mechanical properties of the airways or decreased syst...

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Vydáno v:	Thorax Ročník 70; číslo 7; s. 659 - 667
Hlavní autoři:	van Huisstede, Astrid, Rudolphus, Arjan, Castro Cabezas, Manuel, Biter, Laser Ulas, van de Geijn, Gert-Jan, Taube, Christian, Hiemstra, Pieter S, Braunstahl, Gert-Jan
Médium:	Journal Article
Jazyk:	angličtina
Vydáno:	England BMJ Publishing Group LTD 01.07.2015
Témata:	Adolescent Adult Asthma Asthma - drug therapy Asthma - etiology Asthma - pathology Asthma - physiopathology Bariatric Surgery - methods Biopsy Body mass index Bronchi - pathology Case-Control Studies Comorbidity Drug Administration Schedule Gastrointestinal surgery Glucocorticoids - administration & dosage Humans Inflammation Inflammation - etiology Inflammation Mediators - metabolism Laboratories Longitudinal Studies Middle Aged Obesity Obesity, Morbid - complications Obesity, Morbid - pathology Obesity, Morbid - physiopathology Obesity, Morbid - surgery Physicians Quality of Life Respiratory Mechanics - physiology Studies Weight control Weight Loss - physiology Young Adult Bronchoscopy Asthma Mechanisms Asthma
ISSN:	0040-6376, 1468-3296, 1468-3296
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Abstract	BackgroundThe pathogenesis of asthma in obese subjects is poorly understood and has been described as a specific phenotype in these patients. Weight loss improves asthma control and lung function. Whether this improvement is the result of better mechanical properties of the airways or decreased systemic and bronchial inflammation remains unclear.MethodsA longitudinal study in obese patients with asthma (bariatric surgery and asthma group (BS+A), n=27) and obese control (bariatric surgery without asthma group (BS−A), n=39) subjects undergoing bariatric surgery, and obese patients with asthma without intervention (no bariatric surgery and asthma group (NBS+A), n=12). Lung function, asthma control, cellular infiltrates in bronchial biopsies and circulating markers of systemic inflammation were measured during follow up at 3, 6 and 12 months.ResultsBariatric surgery resulted in a profound weight loss at 12 months. In the BS+A group as well as the BS−A group FEV1, functional residual capacity, total lung capacity improved, whereas FEV1/FVC only improved in the BS−A group. In addition, Asthma Control Questionnaire (ACQ), Asthma Quality of Life Questionnaire, inhaled corticosteroid use and PD20 improved in BS+A, whereas in the NBS+A group only ACQ improved. Small airway function R5–R20 improved in both surgery groups, however the change in the BS+A group was greater, resulting in a comparable R5–R20 between BS+A and BS−A at 12-month follow-up. Besides improvement of systemic inflammation (high sensitivity C-reactive protein, adiponectin and leptin) after BS, only a decrease in mast cell numbers was detectable in the BS+A group.ConclusionsBariatric surgery improved small airway function, decreased systemic inflammation and number of mast cells in the airways. These effects could explain the improvement of asthma control, quality of life and lung function. Therefore bariatric surgery, in addition to all other positive effects, also improves asthma in subjects with morbid obesity.Trial registration number3204.
AbstractList	Background The pathogenesis of asthma in obese subjects is poorly understood and has been described as a specific phenotype in these patients. Weight loss improves asthma control and lung function. Whether this improvement is the result of better mechanical properties of the airways or decreased systemic and bronchial inflammation remains unclear. Methods A longitudinal study in obese patients with asthma (bariatric surgery and asthma group (BS+A), n=27) and obese control (bariatric surgery without asthma group (BS-A), n=39) subjects undergoing bariatric surgery, and obese patients with asthma without intervention (no bariatric surgery and asthma group (NBS+A), n=12). Lung function, asthma control, cellular infiltrates in bronchial biopsies and circulating markers of systemic inflammation were measured during follow up at 3, 6 and 12 months. Results Bariatric surgery resulted in a profound weight loss at 12 months. In the BS+A group as well as the BS-A group FEV1, functional residual capacity, total lung capacity improved, whereas FEV1/FVC only improved in the BS-A group. In addition, Asthma Control Questionnaire (ACQ), Asthma Quality of Life Questionnaire, inhaled corticosteroid use and PD20 improved in BS+A, whereas in the NBS+A group only ACQ improved. Small airway function R5-R20 improved in both surgery groups, however the change in the BS+A group was greater, resulting in a comparable R5-R20 between BS+A and BS-A at 12-month follow-up. Besides improvement of systemic inflammation (high sensitivity C-reactive protein, adiponectin and leptin) after BS, only a decrease in mast cell numbers was detectable in the BS+A group. Conclusions Bariatric surgery improved small airway function, decreased systemic inflammation and number of mast cells in the airways. These effects could explain the improvement of asthma control, quality of life and lung function. Therefore bariatric surgery, in addition to all other positive effects, also improves asthma in subjects with morbid obesity. The pathogenesis of asthma in obese subjects is poorly understood and has been described as a specific phenotype in these patients. Weight loss improves asthma control and lung function. Whether this improvement is the result of better mechanical properties of the airways or decreased systemic and bronchial inflammation remains unclear. A longitudinal study in obese patients with asthma (bariatric surgery and asthma group (BS+A), n=27) and obese control (bariatric surgery without asthma group (BS-A), n=39) subjects undergoing bariatric surgery, and obese patients with asthma without intervention (no bariatric surgery and asthma group (NBS+A), n=12). Lung function, asthma control, cellular infiltrates in bronchial biopsies and circulating markers of systemic inflammation were measured during follow up at 3, 6 and 12 months. Bariatric surgery resulted in a profound weight loss at 12 months. In the BS+A group as well as the BS-A group FEV1, functional residual capacity, total lung capacity improved, whereas FEV1/FVC only improved in the BS-A group. In addition, Asthma Control Questionnaire (ACQ), Asthma Quality of Life Questionnaire, inhaled corticosteroid use and PD20 improved in BS+A, whereas in the NBS+A group only ACQ improved. Small airway function R5-R20 improved in both surgery groups, however the change in the BS+A group was greater, resulting in a comparable R5-R20 between BS+A and BS-A at 12-month follow-up. Besides improvement of systemic inflammation (high sensitivity C-reactive protein, adiponectin and leptin) after BS, only a decrease in mast cell numbers was detectable in the BS+A group. Bariatric surgery improved small airway function, decreased systemic inflammation and number of mast cells in the airways. These effects could explain the improvement of asthma control, quality of life and lung function. Therefore bariatric surgery, in addition to all other positive effects, also improves asthma in subjects with morbid obesity. 3204. Background The pathogenesis of asthma in obese subjects is poorly understood and has been described as a specific phenotype in these patients. Weight loss improves asthma control and lung function. Whether this improvement is the result of better mechanical properties of the airways or decreased systemic and bronchial inflammation remains unclear. Methods A longitudinal study in obese patients with asthma (bariatric surgery and asthma group (BS+A), n=27) and obese control (bariatric surgery without asthma group (BS-A), n=39) subjects undergoing bariatric surgery, and obese patients with asthma without intervention (no bariatric surgery and asthma group (NBS+A), n=12). Lung function, asthma control, cellular infiltrates in bronchial biopsies and circulating markers of systemic inflammation were measured during follow up at 3, 6 and 12 months. Results Bariatric surgery resulted in a profound weight loss at 12 months. In the BS+A group as well as the BS-A group FEV1 , functional residual capacity, total lung capacity improved, whereas FEV1 /FVC only improved in the BS-A group. In addition, Asthma Control Questionnaire (ACQ), Asthma Quality of Life Questionnaire, inhaled corticosteroid use and PD20 improved in BS+A, whereas in the NBS+A group only ACQ improved. Small airway function R5 -R20 improved in both surgery groups, however the change in the BS+A group was greater, resulting in a comparable R5 -R20 between BS+A and BS-A at 12-month follow-up. Besides improvement of systemic inflammation (high sensitivity C-reactive protein, adiponectin and leptin) after BS, only a decrease in mast cell numbers was detectable in the BS+A group. Conclusions Bariatric surgery improved small airway function, decreased systemic inflammation and number of mast cells in the airways. These effects could explain the improvement of asthma control, quality of life and lung function. Therefore bariatric surgery, in addition to all other positive effects, also improves asthma in subjects with morbid obesity. Trial registration number 3204. BackgroundThe pathogenesis of asthma in obese subjects is poorly understood and has been described as a specific phenotype in these patients. Weight loss improves asthma control and lung function. Whether this improvement is the result of better mechanical properties of the airways or decreased systemic and bronchial inflammation remains unclear.MethodsA longitudinal study in obese patients with asthma (bariatric surgery and asthma group (BS+A), n=27) and obese control (bariatric surgery without asthma group (BS−A), n=39) subjects undergoing bariatric surgery, and obese patients with asthma without intervention (no bariatric surgery and asthma group (NBS+A), n=12). Lung function, asthma control, cellular infiltrates in bronchial biopsies and circulating markers of systemic inflammation were measured during follow up at 3, 6 and 12 months.ResultsBariatric surgery resulted in a profound weight loss at 12 months. In the BS+A group as well as the BS−A group FEV1, functional residual capacity, total lung capacity improved, whereas FEV1/FVC only improved in the BS−A group. In addition, Asthma Control Questionnaire (ACQ), Asthma Quality of Life Questionnaire, inhaled corticosteroid use and PD20 improved in BS+A, whereas in the NBS+A group only ACQ improved. Small airway function R5–R20 improved in both surgery groups, however the change in the BS+A group was greater, resulting in a comparable R5–R20 between BS+A and BS−A at 12-month follow-up. Besides improvement of systemic inflammation (high sensitivity C-reactive protein, adiponectin and leptin) after BS, only a decrease in mast cell numbers was detectable in the BS+A group.ConclusionsBariatric surgery improved small airway function, decreased systemic inflammation and number of mast cells in the airways. These effects could explain the improvement of asthma control, quality of life and lung function. Therefore bariatric surgery, in addition to all other positive effects, also improves asthma in subjects with morbid obesity.Trial registration number3204. The pathogenesis of asthma in obese subjects is poorly understood and has been described as a specific phenotype in these patients. Weight loss improves asthma control and lung function. Whether this improvement is the result of better mechanical properties of the airways or decreased systemic and bronchial inflammation remains unclear.BACKGROUNDThe pathogenesis of asthma in obese subjects is poorly understood and has been described as a specific phenotype in these patients. Weight loss improves asthma control and lung function. Whether this improvement is the result of better mechanical properties of the airways or decreased systemic and bronchial inflammation remains unclear.A longitudinal study in obese patients with asthma (bariatric surgery and asthma group (BS+A), n=27) and obese control (bariatric surgery without asthma group (BS-A), n=39) subjects undergoing bariatric surgery, and obese patients with asthma without intervention (no bariatric surgery and asthma group (NBS+A), n=12). Lung function, asthma control, cellular infiltrates in bronchial biopsies and circulating markers of systemic inflammation were measured during follow up at 3, 6 and 12 months.METHODSA longitudinal study in obese patients with asthma (bariatric surgery and asthma group (BS+A), n=27) and obese control (bariatric surgery without asthma group (BS-A), n=39) subjects undergoing bariatric surgery, and obese patients with asthma without intervention (no bariatric surgery and asthma group (NBS+A), n=12). Lung function, asthma control, cellular infiltrates in bronchial biopsies and circulating markers of systemic inflammation were measured during follow up at 3, 6 and 12 months.Bariatric surgery resulted in a profound weight loss at 12 months. In the BS+A group as well as the BS-A group FEV1, functional residual capacity, total lung capacity improved, whereas FEV1/FVC only improved in the BS-A group. In addition, Asthma Control Questionnaire (ACQ), Asthma Quality of Life Questionnaire, inhaled corticosteroid use and PD20 improved in BS+A, whereas in the NBS+A group only ACQ improved. Small airway function R5-R20 improved in both surgery groups, however the change in the BS+A group was greater, resulting in a comparable R5-R20 between BS+A and BS-A at 12-month follow-up. Besides improvement of systemic inflammation (high sensitivity C-reactive protein, adiponectin and leptin) after BS, only a decrease in mast cell numbers was detectable in the BS+A group.RESULTSBariatric surgery resulted in a profound weight loss at 12 months. In the BS+A group as well as the BS-A group FEV1, functional residual capacity, total lung capacity improved, whereas FEV1/FVC only improved in the BS-A group. In addition, Asthma Control Questionnaire (ACQ), Asthma Quality of Life Questionnaire, inhaled corticosteroid use and PD20 improved in BS+A, whereas in the NBS+A group only ACQ improved. Small airway function R5-R20 improved in both surgery groups, however the change in the BS+A group was greater, resulting in a comparable R5-R20 between BS+A and BS-A at 12-month follow-up. Besides improvement of systemic inflammation (high sensitivity C-reactive protein, adiponectin and leptin) after BS, only a decrease in mast cell numbers was detectable in the BS+A group.Bariatric surgery improved small airway function, decreased systemic inflammation and number of mast cells in the airways. These effects could explain the improvement of asthma control, quality of life and lung function. Therefore bariatric surgery, in addition to all other positive effects, also improves asthma in subjects with morbid obesity.CONCLUSIONSBariatric surgery improved small airway function, decreased systemic inflammation and number of mast cells in the airways. These effects could explain the improvement of asthma control, quality of life and lung function. Therefore bariatric surgery, in addition to all other positive effects, also improves asthma in subjects with morbid obesity.3204.TRIAL REGISTRATION NUMBER3204.
Author	Taube, Christian Hiemstra, Pieter S Rudolphus, Arjan Biter, Laser Ulas van de Geijn, Gert-Jan Castro Cabezas, Manuel Braunstahl, Gert-Jan van Huisstede, Astrid
Author_xml	– sequence: 1 givenname: Astrid surname: van Huisstede fullname: van Huisstede, Astrid email: a.vanhuisstede@sfg.nl organization: Department of Pulmonology, Sint Franciscus Gasthuis, Rotterdam, The Netherlands – sequence: 2 givenname: Arjan surname: Rudolphus fullname: Rudolphus, Arjan email: a.vanhuisstede@sfg.nl organization: Department of Pulmonology, Sint Franciscus Gasthuis, Rotterdam, The Netherlands – sequence: 3 givenname: Manuel surname: Castro Cabezas fullname: Castro Cabezas, Manuel email: a.vanhuisstede@sfg.nl organization: Department of Internal Medicine, Sint Franciscus Gasthuis, Rotterdam, The Netherlands – sequence: 4 givenname: Laser Ulas surname: Biter fullname: Biter, Laser Ulas email: a.vanhuisstede@sfg.nl organization: Department of Surgery, Sint Franciscus Gasthuis, Rotterdam, The Netherlands – sequence: 5 givenname: Gert-Jan surname: van de Geijn fullname: van de Geijn, Gert-Jan email: a.vanhuisstede@sfg.nl organization: Department of Clinical Chemistry, Sint Franciscus Gasthuis, Rotterdam, The Netherlands – sequence: 6 givenname: Christian surname: Taube fullname: Taube, Christian email: a.vanhuisstede@sfg.nl organization: Department of Pulmonology, Leiden University Medical Center, Leiden, The Netherlands – sequence: 7 givenname: Pieter S surname: Hiemstra fullname: Hiemstra, Pieter S email: a.vanhuisstede@sfg.nl organization: Department of Pulmonology, Leiden University Medical Center, Leiden, The Netherlands – sequence: 8 givenname: Gert-Jan surname: Braunstahl fullname: Braunstahl, Gert-Jan email: a.vanhuisstede@sfg.nl organization: Department of Pulmonology, Sint Franciscus Gasthuis, Rotterdam, The Netherlands
BackLink	https://www.ncbi.nlm.nih.gov/pubmed/25934136$$D View this record in MEDLINE/PubMed
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DOI	10.1136/thoraxjnl-2014-206712
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Keywords	Bronchoscopy Asthma Mechanisms Asthma
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publication-title: Thorax doi: 10.1136/thorax.58.12.1008 – volume: 122 start-page: 177 year: 2002 ident: key-10.1136/thoraxjnl-2014-206712-23 article-title: Intrabreath diffusing capacity of the lung in healthy individuals at rest and during exercise publication-title: Chest doi: 10.1378/chest.122.1.177 – volume: 14 start-page: 32 year: 1999 ident: key-10.1136/thoraxjnl-2014-206712-26 article-title: Development and validation of the Mini Asthma Quality of Life Questionnaire publication-title: Eur Respir J doi: 10.1034/j.1399-3003.1999.14a08.x – volume: 126 start-page: 2870 year: 2012 ident: key-10.1136/thoraxjnl-2014-206712-8 article-title: Clinical assessment and management of adult obesity publication-title: Circulation doi: 10.1161/CIRCULATIONAHA.111.075424 – volume: 178 start-page: 218 year: 2008 ident: key-10.1136/thoraxjnl-2014-206712-9 article-title: Cluster analysis and clinical asthma phenotypes publication-title: Am J Respir Crit Care Med doi: 10.1164/rccm.200711-1754OC – volume: 106 start-page: 651 year: 2012 ident: key-10.1136/thoraxjnl-2014-206712-15 article-title: Effect of bariatric surgery on airway response and lung function in obese subjects with asthma publication-title: Respir Med doi: 10.1016/j.rmed.2011.12.012 – volume: 6 start-page: 189 year: 2014 ident: key-10.1136/thoraxjnl-2014-206712-34 article-title: Is there a link between obesity and asthma? 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A matter of distal lung compliance publication-title: Am J Respir Crit Care Med doi: 10.1164/rccm.201401-0178OC – volume: 128 start-page: 508 year: 2011 ident: key-10.1136/thoraxjnl-2014-206712-13 article-title: Effects of obesity and bariatric surgery on airway hyperresponsiveness, asthma control, and inflammation publication-title: J Allergy Clin Immunol doi: 10.1016/j.jaci.2011.06.009 – volume: 186 start-page: 598 year: 2012 ident: key-10.1136/thoraxjnl-2014-206712-17 article-title: Obesity and asthma: an inflammatory disease of adipose tissue not the airway publication-title: Am J Respir Crit Care Med doi: 10.1164/rccm.201203-0573OC – volume: 30 start-page: 1030 year: 2009 ident: key-10.1136/thoraxjnl-2014-206712-29 article-title: Development of the GerdQ, a tool for the diagnosis and management of gastro-oesophageal reflux disease in primary care publication-title: Aliment Pharmacol Ther doi: 10.1111/j.1365-2036.2009.04142.x – volume: 68 start-page: 425 year: 2013 ident: key-10.1136/thoraxjnl-2014-206712-7 article-title: Weight loss interventions in asthma: EAACI evidence-based clinical practice guideline (part I) publication-title: Allergy doi: 10.1111/all.12106 – volume: 16 start-page: 5 year: 1993 ident: key-10.1136/thoraxjnl-2014-206712-21 article-title: Lung volumes and forced ventilatory flows. Report Working Party Standardization of Lung Function Tests, European Community for Steel and Coal. Official Statement of the European Respiratory Society publication-title: Eur Respir J Suppl doi: 10.1183/09041950.005s1693 – volume: 190 start-page: 951 year: 2014 ident: key-10.1136/thoraxjnl-2014-206712-11 article-title: Bronchial and systemic inflammation in morbidly obese subjects with asthma: a biopsy study publication-title: Am J Respir Crit Care Med doi: 10.1164/rccm.201407-1225LE – volume: 102 start-page: 102 year: 2008 ident: key-10.1136/thoraxjnl-2014-206712-12 article-title: Weight loss and asthma control in severely obese asthmatic females publication-title: Respir Med doi: 10.1016/j.rmed.2007.07.029 – volume: 355 start-page: 2226 year: 2006 ident: key-10.1136/thoraxjnl-2014-206712-2 article-title: The asthma epidemic publication-title: N Engl J Med doi: 10.1056/NEJMra054308 – volume: 178 start-page: 682 year: 2008 ident: key-10.1136/thoraxjnl-2014-206712-6 article-title: Body mass and glucocorticoid response in asthma publication-title: Am J Respir Crit Care Med doi: 10.1164/rccm.200801-076OC – volume: 171 start-page: 912 year: 2005 ident: key-10.1136/thoraxjnl-2014-206712-22 article-title: ATS/ERS recommendations for standardized procedures for the online and offline measurement of exhaled lower respiratory nitric oxide and nasal nitric oxide, 2005 publication-title: Am J Respir Crit Care Med doi: 10.1164/rccm.200406-710ST – volume: 122 start-page: 507 year: 2008 ident: key-10.1136/thoraxjnl-2014-206712-5 article-title: The relationship between obesity and asthma severity and control in adults publication-title: J Allergy Clin Immunol doi: 10.1016/j.jaci.2008.06.024 – volume: 16 start-page: 53 year: 1993 ident: key-10.1136/thoraxjnl-2014-206712-24 article-title: Airway responsiveness. 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Snippet	BackgroundThe pathogenesis of asthma in obese subjects is poorly understood and has been described as a specific phenotype in these patients. Weight loss... The pathogenesis of asthma in obese subjects is poorly understood and has been described as a specific phenotype in these patients. Weight loss improves asthma... Background The pathogenesis of asthma in obese subjects is poorly understood and has been described as a specific phenotype in these patients. Weight loss...
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SubjectTerms	Adolescent Adult Asthma Asthma - drug therapy Asthma - etiology Asthma - pathology Asthma - physiopathology Bariatric Surgery - methods Biopsy Body mass index Bronchi - pathology Case-Control Studies Comorbidity Drug Administration Schedule Gastrointestinal surgery Glucocorticoids - administration & dosage Humans Inflammation Inflammation - etiology Inflammation Mediators - metabolism Laboratories Longitudinal Studies Middle Aged Obesity Obesity, Morbid - complications Obesity, Morbid - pathology Obesity, Morbid - physiopathology Obesity, Morbid - surgery Physicians Quality of Life Respiratory Mechanics - physiology Studies Weight control Weight Loss - physiology Young Adult
Title	Effect of bariatric surgery on asthma control, lung function and bronchial and systemic inflammation in morbidly obese subjects with asthma
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