Asthma and hyperbilirubinemia: a new aspect to analyze?

One of the concepts of airway inflammation in asthma is the occurrence of oxidative stress defined as the disruption of the balance between the level of oxidants and reductants (antioxidants). Several factors, such as cigarettes, marijuana smoking, air pollution, stress, improper dietary habits e.g. eating processed food with a high content of preservatives, can increase the severity of oxidative stress. Conversely, bilirubin is considered to be a factor having cytoprotective properties which include antioxidant, anti-inflammatory, and antiproliferative effects [1]. However, its total effect on the pulmonary system remains unknown.
We report the case of a 16-year-old boy, admitted to the Allergology Department due to ongoing 5 h of dyspnea and jaundice. The patient had a history of recurrent bronchitis from 3 to 5 years of age approximately 4 times a year, and less from the age of 6 – 2 times a year, but bronchitis was accompanied by prolonged cough of up to 4 weeks. He has poor tolerance of exercise from the age of 10, and reported symptoms which included coughing, wheezing, dyspnea and fatigue especially after physical exercises and swimming. In addition, he sometimes experiences loss of appetite and had also accidentally noticed jaundice on the same days, when he had coughing and wheezing. The patient’s parents attributed the symptoms to intensive studying and examination-related stress, and poor dietary habits as he often ate processed food such as chips and cola. The patient had a history of hyperbilirubinemia (14 mg/dl) at birth, however no further diagnosis had been pursued at the time. Since then, the level of bilirubin has never been marked. The patient had a family history of chronic diseases, negated having alcohol intake, or drug abuse. On physical examination, superficial jaundice, dyspnea, wheezing and pharyngeal erythema were noted. His full blood count values, C protein (1.00 mg/l), reticulocytes (0.5%), iron concentration (87 µg/dl), transferrin saturation (32%), liver function tests (ALT, AST, gGT) were normal despite unconjugated bilirubin (7.49 mg/dl). Tests for lambliasis (stool microscopy and antigen testing), AgHBs and HCV antibodies were negative, abdominal ultrasonography was normal. The pulmonary function test (Spirometer Jaeger) revealed: forced expiratory volume in 1 s (FEV1) 63%, predicted value (PV), forced vital capacity (FVC) 78%, PV, FEV1/FVC – 68%. The challenge test with 400 µg of salbutamol was positive (FEV1 –...


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