Marked improvement in asthma after Lap-Band®:: Surgery for morbid obesity

Background: Asthma and morbid obesity are common chronic conditions that may be related. Laparoscopic banding provides effective weight control of morbid obesity. The aim of this study was to evaluate the prevalence of asthma in the morbidly obese and the changes in asthma after laparoscopic adjustable gastric banding (LAGB) (Lap-Band(R)) surgery for morbid obesity. Methods: Asthma was assessed preoperatively in all patients presenting for LAGB. 32 consecutive asthmatic patients were followed up clinically and by a standard questionnaire at least 12 months after surgery, and any change in asthma impact was recorded. Results: The prevalence of the doctors' diagnosis of asthma was 24.6% (73 of 296 consecutive patients). This was significantly higher than the prevalence in the Australian community of 12% to 13% (P < 0.001). The 32 patients who were followed up had a mean body weight of 125.2 kg and a body mass index (BMI) of 45.7 kg/m(2) prior to operation, and a weight of 89.3 kg (BMI 32.9 kg/m2) at follow-up. All 32 patients recorded a lower asthma score postoperatively. There were significant improvements in all aspects of asthma assessed. These included severity, daily impact, medications needed, hospitalization, sleep, and exercise. The mean preoperative scaled asthma score was 44.5 +/- 16. There was a highly significant reduction at follow-up to a mean value of 14.3 +/- 11 (P < 0.001). Conclusions: There is a high prevalence of asthma in morbidly obese adults, and major reductions in asthma severity occur after Lap-Band(r) surgery and weight loss. Mechanisms other than direct weight loss appear to play a part in this improvement. Prevention of gastroesophageal reflux may be an important factor.