The effect of chronic hepatitis-C virus infection on asthma control, severity, and induced sputum analysis in bronchial asthma patients

Background
Bronchial asthma is a heterogeneous disease, manifested by chronic airway-inflammatory changes. Viral hepatitis-C infection is a major worldwide illness with about 130–150 million that are chronically infected. Hepatitis-C virus (HCV) is associated with liver pathology and extrahepatic manifestations, which can lead to many indirect and direct pulmonary complications. Alteration of airway inflammation may be the underlying mechanism predisposing asthmatics with chronic HCV to more severe asthma. Discrete inflammatory types have been recognized in the sputum of asthmatics. This study aims to assess the effect of HCV infection on asthma control, asthma severity, and airway inflammation and to analyze sputum in bronchial asthma patients graded according to Global Initiative for Asthma Classification.


Patients and methods
This study included 60 adult nonsmoking asthmatic patients who were enrolled from the outpatient clinic of Chest and Tropical Departments, Mansoura University Hospital from February 2016 to September 2017. They were classified into two groups. Group A: patients without HCV infection and group B: patients with chronic HCV infection. Analysis of induced sputum to evaluate airway-inflammatory cell type in relation to asthma control, severity, and treatment step.


Results
Regarding asthma severity and treatment step, there is a significant difference between the two studied groups, while no significant differences in asthma control between the two groups were found. Successfully induced samples illustrated that airway-inflammatory cells varied in both groups; although an eosinophilic phenotype predominates in both groups, a higher percentage was present in group A (50%) than patients in group B (35%), also, paucigranulocytic phenotype was higher in group A than group B. On the other hand, the percentage of neutrophilic and mixed granulocytic phenotypes was more in group B in comparison with group A.


Conclusion
Patients with asthma and chronic HCV infection had a significant later onset of bronchial asthma, eosinophilic phenotype predominated in all asthmatic patients, especially in patients without HCV. High percentage of neutrophils was present in asthmatics with HCV infection and this suggested more severe airway inflammation.