Pulmonary Inflammation and Microbiome Changes With Bariatric Surgery in Obese Asthma

Inclusion Criteria: Asthma Subjects * Outpatient adults of either sex 21-60 years of age with an initial asthma diagnosis at \< 12 years of age (early-onset) or \>12 years of age (late-onset), as defined by the NHLBI NAEPP guidelines (17). * Subjects with obesity (BMI ≥ 30 kg/m2). * Physician diagnosis of asthma. * Eligible and scheduled for bariatric surgery (Roux-en-Y gastric bypass, sleeve gastrectomy or duodenal switch) and receiving care within the Duke Health System. FEV1 within acceptable limits (\>45% predicted before and \>55% predicted after, bronchodilator administration). * Relatively healthy subjects able to undergo sputum induction without complications. * Willing and able to give informed consent and adhere to visit/protocol schedules. * Read and write in English. Non-Asthma Control Subjects * Outpatient adults of either sex 21-60 years of age. * Subjects with obesity (BMI ≥ 30). * Eligible and scheduled for bariatric surgery (Roux-en-Y gastric bypass, sleeve gastrectomy or duodenal switch) at Duke Regional Hospital and receiving care at the Duke Metabolic and -Weight Loss Surgery Center. * Normal lung function. * No clinical history of atopy. * No significant medical or psychological issues. * Healthy subjects able to undergo sputum induction without complications. * Willing and able to give informed consent and adhere to visit/protocol schedules. * Read and write in English. Exclusion Criteria: * Children \< 21 years of age. * Inpatient status. * Ineligibility or not scheduled for bariatric surgery at the Duke Metabolic and Weight Loss Surgery Center. * FEV1 is less than 45% predicted before, or less than 55% predicted after, bronchodilator administration. * Upper or lower respiratory tract infection within one month of the study. * Use of systemic corticosteroids within four weeks of study. * Smoking (tobacco, e-cigarette, vaping or inhaled drugs) history \> 5 pack years or smoking or vaping within the previous six months. * Significant non-asthma pulmonary disease (stable obstructive sleep apnea is not excluded). * An ED visit or inpatient admission for a primary respiratory diagnosis within 60 days of enrollment. * Poorly controlled concomitant conditions that pose additional procedure risk as determined by the investigator. * All patients on anticoagulants. * Uncontrolled sleep apnea.