Camila B Ortega, MD1, Jennifer Ingram, PhD2, Hui-Jie Lee, PhD3, Dimitrios Moris, MD4, Ranjan Sudan, MD1, Keri Seymour, MD1, Jin Yoo, MD1, Chan Park, MD1, Dana Portenier, MD1, Alfredo D Guerron, MD1. 1Duke University Health System. Department of Surgery. Division of Metabolic and Weight Loss Surgery., 2Duke University Health System. Department of Medicine. Division of Pulmonary, Allergy and Critical Care Medicine., 3Duke University Medical Center. Department of Biostatistics and Bioinformatics., 4Duke University Health System. Department of Surgery.
INTRODUCTION: Asthma is an important healthcare problem affecting 25 million people in the U.S with estimated 4000 deaths per year. Approximately 40% of that population suffers with obesity. In 2007, the total cost of asthma was estimated to be $56 billion. Patients with obesity exhibit more severe asthma with poor asthma control and reduced response to therapy, resulting in consumption of disproportionately high amounts of healthcare resources compared to lean patients with asthma. Pulmonary symptoms such as sleep apnea improve after bariatric surgery, and we hypothesized that asthma medication usage would also decrease over time after bariatric surgery.
METHODS: Patients with obesity and with at least one asthma medication prescribed preoperatively, who underwent bariatric surgery at a single academic center, were studied for up to 3 years postoperation. Baseline and postoperative data including demographics, weight and BMI, comorbidities, number of asthma medications, type of procedure, and complications were reviewed. Poisson generalized linear mixed models for repeated measures were used to evaluate the effect of time, procedure type, time and procedure interaction, and risk factors on number of asthma medications.
RESULTS: 751 bariatric patients with at least one asthma medication prescribed preoperatively (mean 1.4±0.6) were evaluated. Mean age at operation was 46.8±11.6, mean weight: 295.9lb±57, BMI: 49kg/m2±8.2; 87.7% were females, 33.4% had diabetes, 44.2% used GERD medication, and 64.4% used hypertension medication. The most common type of procedure performed was RYGB (79%), followed by SG (10.7%), AGB (8.1%), and DS (2.3%).
Compared to baseline, the average number of asthma medications among all procedures were 27% lower at 30 days postoperation (RR 0.73, 95%CI:0.66 to 0.80, p-value <0.0001), 37% lower at 6 months (RR 0.63, 95%CI:0.56 to 0.70, p-value <0.0001), 44% lower at 1 year (RR 0.56, 95%CI:0.50 to 0.63, p-value <0.0001), and 46% lower at 3 years (RR 0.54, 95%CI:0.44 to 0.65, p-value <0.001). There was no significant difference in reduction of asthma medication over time between procedure types (procedure and time interaction p-value 0.71). In the adjusted analysis, the average number of asthma medications was 12% higher in patients with at least one GERD medication prescribed preoperatively (RR 1.12, 95%CI:1.02 to 1.23, p-value 0.015), and it was 8% higher with 10-unit increase in preoperative BMI (RR 1.08, 95%CI:1.02 to 1.14, p-value 0.0055).
CONCLUSION: Overall, bariatric surgery significantly decreases the number of asthma medications over time, starting at 30 days post-procedure and sustained up to 3 years.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86483
Program Number: S035
Presentation Session: Bariatrics 2 Session
Presentation Type: Podium
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