CHEST Guidelines-Response_chest

Response_chest_14 (4)

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The correspondence addresses the potential benefits of bariatric surgery in reducing exacerbations of chronic obstructive pulmonary disease (COPD) and its influence on patients with coexisting conditions such as obesity and psoriasis. The initial discussion references a study by Goto et al. (2018) in "CHEST", suggesting that bariatric surgery decreases emergency department visits or hospitalizations for COPD exacerbations. The authors of the correspondence highlight an interesting overlap where psoriasis, a chronic inflammatory disease, also increases the risk of COPD, possibly due to shared risk factors like smoking and respiratory infections.<br /><br />The letter from Valerio De Vita and Peter R. Hansen proposes that bariatric surgery, which is linked to a decrease in the T helper 17/regulatory T-cell ratio, could be effective in managing coexistent obesity, psoriasis, and COPD. This proposition is built on the immunological relationship between these conditions and obesity-related inflammation.<br /><br />Tadahiro Goto and Kohei Hasegawa respond, presenting exploratory analysis results using a self-controlled case series design. They found a similar risk reduction of COPD exacerbation post-bariatric surgery in patients with and without psoriasis, although this was limited by statistical power due to the small sample of patients with psoriasis. The incidence rate ratio for patients with psoriasis showed a more substantial risk reduction, suggesting the need for further research into the complex interactions between obesity, psoriasis, and COPD.<br /><br />Both correspondences imply that bariatric surgery could benefit a subset of patients struggling with these overlapping conditions, calling for further studies to explore the immunological mechanisms and the broader implications of such interventions.

Keywords

bariatric surgery

COPD exacerbations

obesity

psoriasis

chronic inflammatory disease

immunological relationship

T helper 17/regulatory T-cell ratio

self-controlled case series

risk reduction

shared risk factors