COPD and Hepatitis C

Abstract

To the Editor: Kanazawa et al (February 2003)1Kanazawa H Hirata K Yoshikawa J Accelerated decline of lung function in COPD patients with chronic hepatitis C virus infection: a preliminary study based on small numbers of patients.Chest. 2003; 123: 596-599Abstract Full Text Full Text PDF PubMed Scopus (59) Google Scholar reported an accelerated decline of lung function in COPD patients with concomitant hepatitis C infection. They have suggested that the airway disease may be related to the underlying chronic inflammatory disorder. The concept that chronic inflammation of foregut structures can be associated with airway inflammation and damage struck a cord with us since we have noted a striking excess of cases of treated hypothyroidism among a population of patients with idiopathic chronic cough2Birring SS, Brightling CE, Symon FA et al. Idiopathic chronic cough: association with organ specific autoimmune disease and bronchoalveolar lymphocytosis. Thorax (in press)Google Scholar and in nonsmoking patients with fixed airflow obstruction.3Birring SS Brightling CE Bradding P et al.Clinical, radiologic, and induced sputum features of chronic obstructive pulmonary disease in nonsmokers: a descriptive study.Am J Respir Crit Care Med. 2002; 166: 1078-1083Crossref PubMed Scopus (142) Google Scholar Hypothyroidism is usually due to autoimmune destruction of the thyroid gland and is associated with intrathyroid lymphocytic infiltration. We have shown that idiopathic chronic cough is associated with a BAL lymphocytosis2Birring SS, Brightling CE, Symon FA et al. Idiopathic chronic cough: association with organ specific autoimmune disease and bronchoalveolar lymphocytosis. Thorax (in press)Google Scholar and have suggested that this is due to homing of activated lymphocytes from the primary site of autoimmune inflammation to embryologically related structures such as the airways.2Birring SS, Brightling CE, Symon FA et al. Idiopathic chronic cough: association with organ specific autoimmune disease and bronchoalveolar lymphocytosis. Thorax (in press)Google Scholar3Birring SS Brightling CE Bradding P et al.Clinical, radiologic, and induced sputum features of chronic obstructive pulmonary disease in nonsmokers: a descriptive study.Am J Respir Crit Care Med. 2002; 166: 1078-1083Crossref PubMed Scopus (142) Google Scholar4Birring SS Morgan AJ Prudon B et al.Respiratory symptoms in patients with treated hypothyroidism and inflammatory bowel disease.Thorax. 2003; 58: 533-536Crossref PubMed Scopus (48) Google Scholar The mechanism of airway inflammation and damage in autoimmune thyroid disease, and perhaps in chronic hepatitis C infection, may be analogous to that thought to be responsible for airway complications of inflammatory bowel disease. The concepts that inflammatory bowel disease and autoimmune thyroid disease are associated with airway disease, and that the pathogenesis is similar and not related to thyroid hormone status, are supported by a recent study4Birring SS Morgan AJ Prudon B et al.Respiratory symptoms in patients with treated hypothyroidism and inflammatory bowel disease.Thorax. 2003; 58: 533-536Crossref PubMed Scopus (48) Google Scholar showing a twofold to threefold excess of cough, sputum production, and breathlessness, and a remarkably similar profile of respiratory symptoms, among a cohort of patients with inflammatory bowel disease and among another cohort with treated autoimmune thyroid disease. One important difference between the primary sites of inflammation in chronic hepatitis C infection and autoimmune thyroid disease is that the former condition is treatable. The findings of Kanazawa et al1Kanazawa H Hirata K Yoshikawa J Accelerated decline of lung function in COPD patients with chronic hepatitis C virus infection: a preliminary study based on small numbers of patients.Chest. 2003; 123: 596-599Abstract Full Text Full Text PDF PubMed Scopus (59) Google Scholar with interferon therapy raise the interesting possibility that treatment may modify the airway consequences of chronic inflammation of the foregut. The search is on for other treatable causes of chronic foregut inflammation that might be relevant to airway diseases. COPD is associated with peptic ulcer disease,5Monson RR Duodenal ulcer as a second disease.Gastroenterology. 1970; 59: 712-716PubMed Google Scholar so one possibility worth investigating is that chronic gastric inflammation secondary to Helicobacter pylori infection is a potentially modifiable factor underlying the amplified immune response to cigarette smoking and other pollutants that characterizes COPD. eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiI4ZTVmNjA2ZTY1YzY0ZDI2ZTJjOTE1YTA3MDI1MDM4MSIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjgxMjg1MTIwfQ.RGCQR6ekSenNXkcN-Maix2dH2ROsDKFrG1MhvKVh79e-EaZWjAqaZl5mYi2pgG8bIDKq1wFpUzhFpDtWAC0lGNp7IFBWMYPgT7AIIAM8gUCJ3UAcCtFQdhnl6ATzqTJVeV3rZs-FyaCA_nXfy2w2Xf9efMdBjiuDmdTarFuyIILA6P4EgKcDuhQiQOC9EF9MeQCc3G9GiOD0J6hzF7aoN-I3IcZCr4qnbeLTWKlPFYnbv8h7tM3jq30AAeXM-y5d-J-igCWrhedo_rP7TKtSpW5Rk7gtaF3Jqnr7oD1XmhPUHMjhpBMa_HqtJisy0sQAeVU81qKTO1VKb8Q_Ci6o-Q Download .mp4 (3.94 MB) Help with .mp4 files Supplementary appendix eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiIyMjViNjcwNzM0ZDExNWY0MDc0ZDY1NmIzNTcyN2FjZSIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjgxMjg1MTIwfQ.TJ3o5BIAmL65vVj8NFB7unMDw1QdcOmoE_E-ose4Ywz9gUdn5oD-Gp-5vpcXF21ZObB8pXN4w9T_Q1bv-mWnomvCyfxpVnPQznxSHRjPJg4bLGDmpi1gTLP7tfnPhLj7lobesddQBSvGGKNndDEr0fP-ID7QPEzPMKfw2pqMUwubHBpMd4mtJ1eCeq14If7YHRzM77aEqHdP1j015A6BbysDIHCNkEr6Mwj6A25BYayWE3TJl3ML-7E3237SFdaW9G7seqNRy0kZP3In3K2Zmynbiy6lHWz-F13ytIfoPvyk_ITTbBOO39KfElmEo4Vjj89oqtPxz4_kF8Kn7XzjgA Download .mp4 (2.98 MB) Help with .mp4 files Supplementary appendix Download .zip (10.67 MB) Help with zip files Supplementary appendix COPD and Hepatitis CCHESTVol. 124Issue 5PreviewWe thank Dr. Birring for an interest regarding our study (February 2003).1 Hepatitis C virus (HCV) infection is a major cause of chronic liver disease. However, it has previously been reported that chronic HCV infection is associated with several other syndromes, including cardiomyopathy2 and proliferative glomerulonephritis.3 Therefore, we speculated that there is also an interaction between chronic HCV infection and some pulmonary disorders. Birring et al suggest that airway disease may be related to the underlying chronic inflammatory disorder. Full-Text PDF