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The effect of bariatric surgery in the difficult asthma-obesity phenotype: a case report

The effect of bariatric surgery in the difficult asthma-obesity phenotype: a case report
The effect of bariatric surgery in the difficult asthma-obesity phenotype: a case report
INTRODUCTION
Obesity and asthma have become increasingly prevalent conditions in recent years; they often coexist and place a significant burden on the National Health Service. Asthma in the obese is more difficult to treat than in those with a normal body mass index (BMI) and is associated with resistance to traditional asthma therapies and increased use of healthcare resources. Weight loss can improve asthma control in such patients. The degree of weight loss achieved through dietary strategies, however, is often only modestly successful in this group. Bariatric surgery is increasingly used to achieve sustained significant weight loss in morbid obesity. It may offer under-recognized benefit in the difficult asthma-obesity phenotype.

CASE STUDY
We describe the case of a 32-year-old female with difficult asthma who had a BMI of 45 kg/m(2) at the time of referral to our clinic. Her asthma was uncontrolled despite maximal inhaled therapy, oral therapy with Zafirlukast, and daily high-dose (25 mg) oral prednisolone. Additional therapies (subcutaneous Terbutaline and the steroid-sparing agent Methotrexate) had little impact on asthma control and she remained morbidly obese. She underwent gastric bypass surgery and, over the following 18 months, her BMI dropped to 27.7 kg/m(2), her corticosteroid dose was reduced to 7.5 mg (adrenal insufficiency proven), and maintenance inhaled therapy and oral medications were stopped as she maintained good asthma control.

CONCLUSION
This case demonstrates the dramatic improvement that bariatric surgery can have on asthma symptoms and medication use in morbidly obese patients with very difficult to control asthma.
Adult, Asthma/physiopathology, Bariatric Surgery/methods, Body Mass Index, Female, Humans, Obesity, Morbid/physiopathology, Weight Loss
0277-0903
52-55
Evans, Sian
cfe271a8-b372-4ad8-99f0-47ae2e5b1975
Kurukulaaratchy, Ramesh J.
9c7b8105-2892-49f2-8775-54d4961e3e74
Evans, Sian
cfe271a8-b372-4ad8-99f0-47ae2e5b1975
Kurukulaaratchy, Ramesh J.
9c7b8105-2892-49f2-8775-54d4961e3e74

Evans, Sian and Kurukulaaratchy, Ramesh J. (2013) The effect of bariatric surgery in the difficult asthma-obesity phenotype: a case report. Journal of Asthma, 50 (1), 52-55. (doi:10.3109/02770903.2012.741639).

Record type: Article

Abstract

INTRODUCTION
Obesity and asthma have become increasingly prevalent conditions in recent years; they often coexist and place a significant burden on the National Health Service. Asthma in the obese is more difficult to treat than in those with a normal body mass index (BMI) and is associated with resistance to traditional asthma therapies and increased use of healthcare resources. Weight loss can improve asthma control in such patients. The degree of weight loss achieved through dietary strategies, however, is often only modestly successful in this group. Bariatric surgery is increasingly used to achieve sustained significant weight loss in morbid obesity. It may offer under-recognized benefit in the difficult asthma-obesity phenotype.

CASE STUDY
We describe the case of a 32-year-old female with difficult asthma who had a BMI of 45 kg/m(2) at the time of referral to our clinic. Her asthma was uncontrolled despite maximal inhaled therapy, oral therapy with Zafirlukast, and daily high-dose (25 mg) oral prednisolone. Additional therapies (subcutaneous Terbutaline and the steroid-sparing agent Methotrexate) had little impact on asthma control and she remained morbidly obese. She underwent gastric bypass surgery and, over the following 18 months, her BMI dropped to 27.7 kg/m(2), her corticosteroid dose was reduced to 7.5 mg (adrenal insufficiency proven), and maintenance inhaled therapy and oral medications were stopped as she maintained good asthma control.

CONCLUSION
This case demonstrates the dramatic improvement that bariatric surgery can have on asthma symptoms and medication use in morbidly obese patients with very difficult to control asthma.

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More information

e-pub ahead of print date: 22 November 2012
Published date: February 2013
Keywords: Adult, Asthma/physiopathology, Bariatric Surgery/methods, Body Mass Index, Female, Humans, Obesity, Morbid/physiopathology, Weight Loss

Identifiers

Local EPrints ID: 446568
URI: http://eprints.soton.ac.uk/id/eprint/446568
ISSN: 0277-0903
PURE UUID: 2b942616-296d-4050-a373-4cb030a0135a
ORCID for Ramesh J. Kurukulaaratchy: ORCID iD orcid.org/0000-0002-1588-2400

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Date deposited: 15 Feb 2021 17:31
Last modified: 18 Feb 2021 16:54

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Author: Sian Evans

University divisions

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