To The Editor:

We thank Huisstede and colleagues for their interest in our publication and their comments.1 Like the authors we agree wholeheartedly that weight reduction is key to improving asthma control and quality of life in obese patients, and that bariatric surgery is one treatment option to help achieve this. However, access to bariatric surgery varies between countries. In the UK, this option is only available for patients with a BMI range of 35-40 together with additional medical problems such as type 2 diabetes or high blood pressure proven to be improved by marked weight loss, or a BMI >40. This does not include the obese asthmatics that took part in our study (mean BMI of 28). We note that while Huisstede and colleagues found no difference in the eosinophil count between obese asthmatics and obese controls in their analysis,2 their patients were a very different cohort (with a BMI >45) compared to our group. Therefore we believe it is difficult to draw comparisons between the two studies.