Effects of obesity and bariatric surgery on airway hyperresponsiveness, asthma control, and inflammation

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• 作者：Anne E.  ; Dixon MA ; BM BCh^a ;   ; ^{Anne.dixon@vtmednet.org} ; Richard E.  ; Pratley MD^a ; Patrick M.  ; Forgione MD^b ; David A.  ; Kaminsky MD^a ; Laurie A.  ; Whittaker-Leclair MD^a ; Laurianne A.  ; Griffes BA^a ; Jayanthi  ; Garudathri MS^a ; Danielle  ; Raymond BS^a ; Mathew E.  ; Poynter PhD^a ; Janice Y.  ; Bunn PhD^c ; Charles G.  ; Irvin PhD^a
• 关键词：Obesity ; asthma ; bariatric surgery ; weight loss ; airway hyperreactivity ; CD4 T cell
• 刊名：Journal of Allergy and Clinical Immunology
• 出版年：2011
• 出版时间：September 2011
• 年：2011
• 卷：128
• 期：3
• 页码：508-515.e2
• 全文大小：382 K
• ISSN：S0091674911009249

文摘

Background

Asthma in obese subjects is poorly understood, and these patients are often refractory to standard therapy.

Objectives

We sought to gain insights into the pathogenesis and treatment of asthma in obese subjects by determining how obesity and bariatric surgery affect asthma control, airway hyperresponsiveness (AHR), and markers of asthmatic inflammation.

Methods

We performed a prospective study of (1) asthmatic and nonasthmatic patients undergoing bariatric surgery compared at baseline and (2) asthmatic patients followed for 12 months after bariatric surgery.

Results

We studied 23 asthmatic and 21 nonasthmatic patients undergoing bariatric surgery. At baseline, asthmatic patients had lower FEV₁ and forced vital capacity and lower numbers of lymphocytes in bronchoalveolar lavage fluid. After surgery, asthmatic participants experienced significant improvements in asthma control (asthma control score, 1.55 to 0.74; P?< .0001) and asthma quality of life (4.87 to 5.87, P?< .0001). Airways responsiveness to methacholine improved significantly (methacholine PC₂₀, 3.9 to 7.28, P?= .03). There was a statistically significant interaction between IgE status and change in airways responsiveness (P for interaction?= .01). The proportion of lymphocytes in bronchoalveolar lavage fluid and the production of cytokines from activated peripheral blood CD4⁺ T cells increased significantly.

Conclusions

Bariatric surgery improves AHR in obese asthmatic patients with normal serum IgE levels. Weight loss has dichotomous effects on airway physiology and T-cell function typically involved in the pathogenesis of asthma, suggesting that obesity produces a unique phenotype of asthma that will require a distinct therapeutic approach.