Asthma and obesity: capabilities of bariatric surgery

The phenotype of asthma and obesity is an urgent problem of modern medicine. A number of studies have shown that obesity increases the risk of developing asthma by 1.4 – 2.6 times. It has been found that asthma in obese people is often associated with a larger number of symptoms, more pronounced impairment of pulmonary function, and a high need for inhaled drugs. Weight loss provides health benefits against many comorbidities such as obesity, but diet, exercise, and even pharmacologically induced weight loss are associated with poor long­term effectiveness. Bariatric surgery is a promising intervention for weight loss and long­term control of obesity­related comorbidities, including asthma. The purpose of this work is to summarize data on the effect of bariatric surgery on the course of asthma. Results. Available data support the effectiveness of bariatric methods in the treatment of asthma with morbid obesity: weight loss has a beneficial effect on asthma, its control and reduces the use of emergency medications, asthma exacerbations, hospitalizations, and also leads to improved quality of life and functional lung tests. The mechanisms that explain the improvement and sometimes remission of asthma after bariatric surgery are likely multifactorial. At the same time, it should be noted that the reported results of bariatric surgery in patients with asthma mostly come from observational studies, which have many limitations, including small numbers of patients, lack of clear endpoints, lack of standardization of diagnosis, classification and evaluation of asthma treatment results. Most studies do not specify the severity of asthma, and in those that do, most patients had mild or moderate asthma. It remains unclear whether the effect differs depending on the phenotype of the obese asthmatic patient. Also, at present, there is practically no data on differences in the effectiveness and safety of the method of surgical intervention used in patients with asthma. Conclusion. Bariatric techniques should be considered a treatment option in morbidly obese patients with severe asthma after the previous failure of medical, dietary, physical, and psychotherapeutic treatments.

1. Okoniewski W., Lu K.D., Forno E. Weight loss for children and adults with obesity and asthma. A systematic review of randomized controlled trials. Ann. Am. Thorac. Soc. 2019; 16 (5): 613–625. DOI: 10.1513/AnnalsATS.201810-651SR.

2. Ather J.L., Chung M., Hoyt .L.R. et al. Weight loss decreases inherent and allergic methacholine hyperresponsiveness in mouse models of diet-induced obese asthma. Am. J. Respir. Cell Mol. Biol. 2016; 55 (2): 176–187. DOI: 10.1165/rcmb.2016-0070OC.

3. Bantulà M., Roca-Ferrer J., Arismendi E., Picado C. Asthma and obesity: two diseases on the rise and bridged by inflammation. J. Clin. Med. 2021; 10 (2): 169. DOI: 10.3390/jcm10020169.

4. Parasuaraman G., Ayyasamy L., Aune D. et al. The association between body mass index, abdominal fatness, and weight change and the risk of adult asthma: a systematic review and meta-analysis of cohort studies. Sci. Rep. 2023; 13 (1): 7745. DOI: 10.1038/s41598-023-31373-6.

5. Dedov I.I., Mel'nichenko G.A., Shestakova M.V. et al. [Russian national clini-cal recommendations for morbid obesity treatment in adults. 3rd revision (morbid obe-sity treatment in adults)]. Ozhirenie i metabolizm. 2018; 15 (1): 53–70. DOI: 10.14341/omet2018153-70 (in Russian).

6. Andolfi C., Fisichella P.M. Epidemiology of obesity and associated comorbidi-ties. J. Laparoendosc Adv. Surg. Tech. A. 2018; 28 (8): 919–924. DOI: 10.1089/lap.2018.0380.

7. Dhabuwala A., Cannan R.J., Stubbs R.S. Improvement in co-morbidities fol-lowing weight loss from gastric bypass surgery. Obes. Surg. 2000; 10 (5): 428–435. DOI: 10.1381/096089200321594291.

8. Camargo C.A. Jr, Weiss S.T., Zhang S. et al. Prospective study of body mass index, weight change, and risk of adult-onset asthma in women. Arch. Intern. Med. 1999; 159 (21): 2582–2588. DOI: 10.1001/archinte.159.21.2582.

9. Dixon A.E., Holguin F., Sood A. et al. An official American Thoracic Society Workshop report: Obesity and asthma. Proc. Am. Thorac. Soc. 2010; 7 (5): 325–335. DOI: 10.1513/pats.200903-013ST.

10. Chaaban T.A. Bariatric surgery: a potential cure for asthma? Eur. Respir. Rev. 2019; 28 (152): 190003. DOI: 10.1183/16000617.0003-2019.

11. Guerron A.D., Ortega C.B., Lee H.J. et al. Asthma medication usage is signif-icantly reduced following bariatric surgery. Surg. Endosc. 2019; 33 (6): 1967–1975. DOI: 10.1007/s00464-018-6500-x.

12. Dixon J.B., Chapman L., O’Brien P. Marked improvement in asthma after Lap-Band surgery for morbid obesity. Obes. Surg. 1999; 9 (4): 385–389. DOI: 10.1381/096089299765552981.

13. Reddy R.C., Baptist A.P., Fan Z. et al. The effects of bariatric surgery on asthma severity. Obes. Surg. 2011; 21 (2): 200–206. DOI: 10.1007/s11695-010-0155-6.

14. Peters U., Dixon A.E., Forno E. Obesity and asthma. J. Allergy Clin. Immu-nol. 2018; 141 (4): 1169–1179. DOI: 10.1016/j.jaci.2018.02.004.

15. Farzan S., Coyle T., Coscia G. et al. Clinical characteristics and management strategies for adult obese asthma patients. J. Asthma Allergy. 2022; 15: 673–689. DOI: 10.2147/JAA.S285738.

16. Wei Y.F., Wu H.D. Candidates for bariatric surgery: morbidly obese patients with pulmonary dysfunction. J. Obes. 2012; 2012: 878371. DOI: 10.1155/2012/878371.

17. Bantulà M., Tubita V., Roca-Ferrer J. et al. Differences in inflammatory cyto-kine profile in obesity-associated asthma: effects of weight loss. J. Clin. Med. 2022; 11 (13): 3782. DOI: 10.3390/jcm11133782.

18. Dixon A.E., Pratley R.E., Forgione P.M. et al. Effects of obesity and bariatric surgery on airway hyperresponsiveness, asthma control, and inflammation. J. Allegy Clin. Immunol. 2011; 128 (3): 508-15.e1-2. DOI: 10.1016/j.jaci.2011.06.009.

19. Sideleva O., Suratt B.T., Black K.E. et al Obesity and asthma: an inflammato-ry disease of adipose tissue not the airway. Am. J. Respir. Crit. Care Med. 2012; 186 (7): 598–605. DOI: 10.1164/rccm.201203-0573OC.

20. Al-Alwan A., Bates J.H., Chapman D.G. et al. The nonallergic asthma of obe-sity: a matter of distal lung compliance. Am. J. Respir. Crit. Care Med. 2014; 189 (12): 1494–502. DOI: 10.1164/rccm.201401-0178OC.

21. Chapman D.G., Irvin C.G., Kaminsky D.A. et al. Influence of distinct asthma phenotypes on lung function following weight loss in the obese. Respirology. 2014; 19 (8): 1170–1177. DOI: 10.1111/resp.12368.

22. Sikka N., Wegienka G., Havstad S. et al. Respiratory medication prescriptions before and after bariatric surgery. Ann. Allergy Asthma Immunol. 2010; 104 (4): 326–330. DOI: 10.1016/j.anai.2009.12.009.

23. van Huisstede A., Castro Cabezas M., van de Geijn G.J. et al. Underdiagsis and overdiagnosis of asthma in the morbidly obese. Respir. Med. 2013; 107 (9): 1356–1364. DOI: 10.1016/j.rmed.2013.05.007.

24. Switzer N.J. Current trends in obesity: body composition assessment, weight regulation, and emerging techniques in managing severe obesity. J. Interv. Gastroen-terol. 2013; 3 (1): 34. DOI: 10.7178/jig.106.

25. De Luca M., Angrisani L., Himpens J. et al. Indications for surgery for obesity and weight-related diseases: position statements from the International Federation for the surgery of obesity and metabolic disorders (IFSO). Obes. Surg. 2016; 26 (8):1659–1696. DOI: 10.1007/s11695-016-2271-4.

26. van Huisstede A., Rudolphus A., Castro Cabezas M. et al. Effect of bariatric surgery on asthma control, lung function and bronchial and systemic inflammation in morbidly obese subjects with asthma. Thorax. 2015; 70 (7): 659–667. DOI: 10.1136/thoraxjnl-2014-206712.

27. Kalinowski P., Paluszkiewicz R., Wróblewski T. et al. Ghrelin, leptin, and gly-cemic control after sleeve gastrectomy versus Roux-en-Y gastric bypass-results of a randomized clinical trial. Surg. Obes. Relat. Dis. 2017; 13 (2): 181–188. DOI: 10.1016/j.soard.2016.08.025.

28. Marantos G., Daskalakis M., Karkavitsas N. et al. Changes in metabolic prfile and adipoinsular axis in morbidly obese premenopausal females treated with restric-tive bariatric surgery. World J. Surg. 2011; 35 (9): 2022–2030. DOI: 10.1007/s00268-011-1165-9.

29. Felipo V., Urios A., García-Torres M.L. et al. Alterations in adipocytokines and cGMP homeostasis in morbid obesity patients reverse after bariatric surgery. Obesity (Silver Spring). 2013; 21 (2): 229–237. DOI: 10.1002/oby.20008.

30. Kelly A.S., Ryder J.R., Marlatt K.L. et al. Changes in inflammation, oxidative stress and adipokines following bariatric surgery among adolescents with severe obesity. Int. J. Obes. (Lond.). 2016; 40 (2): 275–280. DOI: 10.1038/ijo.2015.174.

31. Baltieri L., Cazzo E., de Souza A.L. et al. Influence of weight loss on pulmnary function and levels of adipokines among asthmatic individuals with obesity: one-year follow-up. Respir. Med. 2018; 145: 48–56. DOI: 10.1016/j.rmed.2018.10.017.

32. Boulet L.P., Turcotte H., Martin J., Poirier P. Effect of bariatric surgery on airway response and lung function in obese subjects with asthma. Respir. Med. 2012; 106 (5): 651–660. DOI: 10.1016/j.rmed.2011.12.012.

33. Bantulà M., Tubita V., Roca-Ferrer J. et al. Weight loss and vitamin D im-prove hyporesponsiveness to corticosteroids in obese asthma. J. Investig. Allergol. Clin. Immunol. 2023; 33 (6): 464–473. DOI: 10.18176/jiaci.0861.

34. Spivak H., Hewitt M.F., Onn A., Half E.E. Weight loss and improvement of obesity-related illness in 500 U.S. patients following laparoscopic adjustable gastric banding procedure. Am. J. Surg. 2005; 189 (1): 27–32. DOI: 10.1016/j.amjsurg.2004.06.038.

35. Maniscalco M., Zamparelli A.S., Vitale D.F. et al. Long-term effect of weight loss induced by bariatric surgery on asthma control and health related quality of life in asthmatic patients with severe obesity: a pilot study. Respir. Med. 2017; 130: 69–74. DOI: 10.1016/j.rmed.2017.06.010.

36. Juel C.T., Ali Z., Nilas L., Ulrik C.S. Asthma and obesity: does weight loss improve asthma control? A systematic review. J. Asthma Allergy. 2012; 5: 21–26. DOI: 10.2147/JAA.S32232.

37. Santos L.M., Ramos B., Almeida J. et al. The impact of weight loss beyond lung function: benefit with respect to asthma outcomes. Pulmonology. 2019; 25 (6): 313–319. DOI: 10.1016/j.pulmoe.2019.07.007.

38. Hewitt S., Humerfelt S., Søvik T.T. et al. Long-term improvements in pulmo-nary function 5 years after bariatric surgery. Obes. Surg. 2014; 24 (5): 705–711. DOI: 10.1007/s11695-013-1159-9.

39. Witte J., Singh H., Turk Y. et al. Effect of bariatric surgery on lung function and asthma control after 8 years of follow-up. Allergy Asthma Proc. 2023; 44 (3): 165–170. DOI: 10.2500/aap.2023.44.230009.

40. Lombardi C., Gargioni S., Gardinazzi A. et al. Impact of bariatric surgery on pulmonary function and nitric oxide in asthmatic and non-asthmatic obese patients. J. Asthma. 2011; 48 (6): 553–557. DOI: 10.3109/02770903.2011.587581.

41. Hossain N., Arhi C., Borg C.M. Is bariatric surgery better than nonsurgical weight loss for improving asthma control? A systematic review. Obes. Surg. 2021; 31 (4): 1810–1832. DOI: 10.1007/s11695-021-05255-7.

42. Maniscalco M., Zedda A., Faraone S. et al. Weight loss and asthma control in severely obese asthmatic females. Respir. Med. 2008; 102 (1): 102–108. DOI: 10.1016/j.rmed.2007.07.029.

43. Toh J.J., Pasupathy S., Poopalalingam R.A., Koh M.S. Can bariatric surgery be performed safely in patients with severe treatment-resistant asthma? Obes. Surg. 2014; 24 (2): 334–336. DOI: 10.1007/s11695-013-1138-1.

44. O'Brien P.E., Dixon J.B, Brown W. et al. The laparoscopic adjustable gastric band (Lap-Band): a prospective study of medium-term effects on weight, health and quality of life. Obes. Surg. 2002; 12 (5): 652–660. DOI: 10.1381/096089202321019639.

45. Hasegawa K., Tsugawa Y., Chang Y., Camargo C.A. Jr. Risk of an asthma exacerbation after bariatric surgery in adults. J. Allergy Clin. Immunol. 2015; 136 (2): 288-94.e8. DOI: 10.1016/j.jaci.2014.12.1931.

46. Forno E., Zhang P., Nouraie M. et al. The impact of bariatric surgery on asthma control differs among obese individuals with reported prior or current astma, with or without metabolic syndrome. PLoS One. 2019; 14 (4): e0214730. DOI: 10.1371/journal.pone.0214730.

47. Simard B., Turcotte H., Marceau P. et al. Asthma and sleep apnea in patients with morbid obesity: outcome after bariatric surgery. Obes. Surg. 2004; 14 (10): 1381–1388. DOI: 10.1381/0960892042584021.

48. Macgregor A.M., Greenberg R.A. Effect of surgi-cally induced weight loss on asthma in the morbidly obese. Obes. Surg. 1993; 3 (1): 15–21. DOI: 10.1381/096089293765559700.

49. Sultan S., Parikh M., Youn H. et al. Early U.S. outcomes after laparoscopic adjustable gastric banding in patients with a body mass index less than 35 kg/m2. Surg. Endosc. 2009; 23 (7): 1569–1573. DOI: 10.1007/s00464-009-0341-6.

50. Murr M.M., Siadati M.R., Sarr M.G. Results of bariatric surgery for morbid obesity in patients older than 50 years. Obes. Surg. 1995; 5 (4): 399–402. DOI: 10.1381/096089295765557494.

51. Rajalingham S., Das S. How obesity and bariatric surgery can affect asthma control. J. Allergy Clin. Immunol. 2012; 129 (1): 268–269. DOI: 10.1016/j.jaci.2011.10.011.

52. Schumann R., Shikora S.A., Sigl J.C., Kelley S.D. Association of metabolic syndrome and surgical factors with pulmonary adverse events, and longitudinal mor-tality in bariatric surgery. Br. J. Anaesth. 2015; 114 (1): 83–90. DOI: 10.1093/bja/aeu362.

53. Nyenhuis S.M., Dixon A.E., Ma J. Impact of lifestyle interventions targeting healthy diet, physical activity, and weight loss on asthma in adults: what is the evi-dence? J. Allergy Clin. Immunol. Pract. 2018; 6 (3): 751–763. DOI: 10.1016/j.jaip.2017.10.026.

54. van Huisstede A., Biter L.U., Luitwieler R. et al. Pulmonary function testing and complications of laparoscopic bariatric surgery. Obes. Surg. 2013; 23 (10): 1596–1603. DOI: 10.1007/s11695-013-0928-9.

55. Iyer U.S., Koh K.F., Chia N.C. et al. Perioperative risk factors in obese pa-tients for bariatric surgery: a Singapore experience. Singapore Med. J. 2011; 52 (2): 94–99. Available at: http://www.smj.org.sg/article/perioperative-risk-factors-obese-patients-bariatric-surgery-singapore-experience

56. Ballantyne G.H., Svahn J., Capella R.F. et al. Predictors of prolonged hospital stay following open and laparoscopic gastric bypass for morbid obesity: body mass index, length of surgery, sleep apnea, asthma, and the metabolic syndrome. Obes. Surg. 2004; 14 (8): 1042–1050. DOI: 10.1381/0960892041975460.

57. Tao W., Plecka-Östlund M., Lu Y. et al. Causes and risk factors for mortality within 1 year after obesity surgery in a population-based cohort study. Surg. Obes. Relat. Dis. 2015; 11 (2): 399–405. DOI: 10.1016/j.soard.2014.08.015.