Clinical study
Accelerated decline in lung function and impaired reversibility with salbutamol in asthmatic patients with chronic hepatitis c virus infection: a 6-year follow-up study

https://doi.org/10.1016/j.amjmed.2003.12.026Get rights and content

Abstract

Purpose

Chronic hepatitis C virus (HCV) infection may have adverse effects on pulmonary function in patients with chronic obstructive pulmonary disease. This prospective study was designed to determine whether chronic HCV infection affects decline in lung function and airway responses to salbutamol in asthmatic patients.

Methods

Interferon α (6 MIU three times a week for 6 months) was given to 55 HCV-positive asthmatic patients, 18 of whom had a virologic response to interferon. Pre- and postbronchodilator forced expiratory volume in 1 second (FEV1) and reversibility with salbutamol or oxitropium at years 1, 3, and 6 after interferon therapy were examined.

Results

We found a significant decrease in pre- and postbronchodilator FEV1 from year 1 to years 3 and 6 only in interferon nonresponders. Reversibility with salbutamol at years 3 and 6 was significantly lower in interferon nonresponders than in HCV-negative patients (P <0.0001) and interferon responders (P <0.0001). Moreover, there was a steep decline in reversibility with salbutamol during the follow-up period only in interferon nonresponders. In contrast, reversibility with oxitropium at years 3 and 6 was significantly higher in interferon nonresponders than in HCV-negative patients and interferon responders, and there was a steep increase in reversibility with oxitropium only in interferon nonresponders. In addition, declines in the diffusing capacity of the lung for carbon monoxide during follow-up were significantly greater in interferon nonresponders than in HCV-negative patients and interferon responders.

Conclusion

Chronic HCV infection is associated with an accelerated decline in lung function and impaired reversibility with salbutamol among asthmatic patients who do not respond to interferon therapy.

Section snippets

Methods

Sixty HCV-positive patients with a diagnosis of asthma according to the American Thoracic Society guidelines were recruited for this study (7). We have studied asthmatic patients since 1992 in a region (Osaka City, Japan) that has an extraordinarily high incidence of HCV infection. Pulmonary function tests and responses to bronchodilators (β2-adrenoceptor agonists and anticholinergic agents) were examined regularly in these patients at 1-year intervals. HCV-positive patients were selected

Results

At the start of the study, the three groups of patients with asthma (20 HCV-negative, 18 interferon responders, and 37 interferon nonresponders) had similar age, sex, and baseline lung function (Table 1), although serum aminotransferase levels were significantly lower in HCV-negative patients. One year after interferon therapy, mean (± SD) aminotransferase levels were significantly lower in interferon responders (aspartate aminotransferase: 25 ± 10 U/L; alanine aminotransferase: 22 ± 9 U/L)

Discussion

We found that pre- or postbronchodilator FEV1 at year 6 after interferon therapy was significantly lower in interferon nonresponders than in HCV-negative patients and in interferon responders. Moreover, a steep decline in reversibility with salbutamol occurred only in interferon nonresponders, whereas there was a steep increase in reversibility with oxitropium in those patients. It seems unlikely that interferon therapy directly influenced airway responses to salbutamol or oxitropium apart from

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This work was supported by a Grant-in-Aid for Scientific Research (15590820) from the Japan Society for the Promotion of Science.

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