CHEST Guidelines-Response_chest

Response_chest_13 (6)

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The response to the editor addresses the findings and implications of a study on the effects of bariatric surgery for reducing the risk of acute exacerbation of COPD (AECOPD), especially considering the presence of obstructive sleep apnea (OSA) and psoriasis. The authors acknowledge agreement with Dr. Kaminska and colleagues regarding the beneficial effects of bariatric surgery, aiming at reducing the severity of OSA, among other non-OSA-related factors. They provide reanalyzed data showing that the risk reduction of AECOPD post-bariatric surgery is significant in patients with and without OSA, albeit more pronounced in those with OSA. This suggests that the benefits are not solely due to improvements in OSA, but also involve reduced inflammation, improved metabolic syndrome, and changes to the gut microbiome.<br /><br />Further insights are given into the potential joint management of obesity, psoriasis, and COPD through bariatric surgery, prompted by inquiries from another study. The editor's response includes an exploratory reanalysis stratifying patients by psoriasis comorbidity, despite a limited sample size. This analysis confirms the post-bariatric surgery reduction in COPD exacerbations in both psoriasis and non-psoriasis individuals, supporting the idea that bariatric surgery offers broader benefits, potentially linked by shared inflammatory mechanisms such as T helper 17-driven pathways. However, statistical power remains constrained for the psoriasis subgroup.<br /><br />Overall, these discussions highlight the emerging focus on the interconnected nature of obesity, OSA, psoriasis, and COPD, advocating for further research into how bariatric surgery could offer a comprehensive management strategy for patients experiencing these concurrent conditions.

Keywords

bariatric surgery

COPD

acute exacerbation

obstructive sleep apnea

psoriasis

inflammation

metabolic syndrome

gut microbiome

T helper 17

obesity management