哮喘联盟

   摘要
   背景：虽然非手术减重干预只达到中等程度降低体重的效果，但是减重干预对哮喘控制效果的研究并未得到一致的结果。
   目的：我们旨在验证减重手术能快速持续降低哮喘急性发作风险这一假设的真实性。
   方法：来自3个州（加利福尼亚州、佛罗里达州和内布拉斯加州）的急诊科（ED）和住院患者样本中进行减重手术的2261例18～54岁的肥胖患者进行一项自身对照病例系统研究。首要研究终点事件是2005年～2011年间因哮喘恶化入住ED或住院治疗。我们采用条件逻辑回归模型以术前第13～24个月作为参考期，比较连续12个月每位患者终点事件发生的风险。
   结果：在参考期内，22.0%（95% 可信区间, 20.3%-23.7%）的患者因为哮喘急性加重急诊就诊或住院治疗。与参考期相比，在连续的术前12个月，风险并没有很大变化(21.7%，95%可信区间, 20.0% t-23.4%），比值比（OR）为0.98（95%可信区间, 0.85-1.13）。相反，在减重手术后的连续12个月因哮喘急性加重入住ED或住院治疗的发生率显著降低（10.9%; 95% 可信区间, 9.6% -12.2%），与此一致的OR为0.42(95% 可信区间, 0.35-0.50。相似的，在术后的第13～24个月，风险发生率仍显著降低(10.9%; 95%可信区间I, 9.6% - 12.2%)，OR为0.42 (95% 可信区间, 0.35-0.50)。
   结论：肥胖患者在进行减重手术后因哮喘急性加重急诊就诊或住院治疗的风险降低一半，表明显著降低体重能有效降低哮喘发病率。
 

（杨冬 审校）
JAllergyClinImmunol.2015Feb7.pii:S0091-6749(15)00012-3.doi:10.1016/j.jaci.2014.12.1931. [Epub ahead of print]
 

Risk of an asthma exacerbation after bariatric surgery in adults.

Hasegawa K1, Tsugawa Y2, Chang Y3, Camargo CA Jr4.

ABSTRACT
BACKGROUND: Research on nonsurgical weight loss interventions has failed to demonstrate consistent efficacy on asthma control, although these interventions resulted in only modest weight reductions.
OBJECTIVE: We sought to test the hypothesis that bariatric surgery is associated with a rapid and sustained decrease in risk of asthma exacerbation.
METHODS: We performed a self-controlled case series study of 2261 obese patients with asthma aged 18 to 54 years who underwent bariatric surgery using the population-based emergency department (ED) and inpatient sample in 3 states (California, Florida, and Nebraska). The primary outcome was an ED visit or hospitalization for asthma exacerbation from 2005 through 2011. We used conditional logistic regression to compare each patient's risk of the outcome event during sequential 12-month periods using presurgery months 13 to 24 as the reference period.
RESULTS: During the reference period, 22.0% (95% CI, 20.3% to 23.7%) of patients had an ED visit or hospitalization for asthma exacerbation. In the subsequent 12-month presurgery period, the risk did not materially change (21.7%; 95% CI, 20.0% to 23.4%), with an odds ratio (OR) of 0.98 (95% CI, 0.85-1.13) compared with the reference period. By contrast, significantly fewer ED visits or hospitalizations for asthma exacerbation occurred within 12 months after bariatric surgery (10.9%; 95% CI, 9.6% to 12.2%), corresponding to an OR of 0.42 (95% CI, 0.35-0.50). Similarly, in the subsequent period of 13 to 24 months after bariatric surgery, the risk remained significantly lower (10.9%; 95% CI, 9.6% to 12.2%), corresponding to an OR of 0.42 (95% CI, 0.35-0.50).
CONCLUSION: In obese patients the risk of an ED visit or hospitalization for asthma exacerbation decreased by half after bariatric surgery. This reduction suggests the effectiveness of significant weight loss on asthma morbidity.
 

JAllergyClinImmunol.2015Feb7.pii:S0091-6749(15)00012-3.doi:10.1016/j.jaci.2014.12.1931. [Epub ahead of print]