Introduction NAFLD is a spectrum of liver disease that encompasses Nonalcoholic fatty liver (NAFL) and nonalcoholic steatohepatitis (NASH). The pathophysiology is not fully understood, but is believed to be a combination of insulin resistance leading to steatosis and subsequent oxidative injury. Known risk factors include obesity, diabetes and dyslipidaemia.
Severe asthma may entail frequent corticosteroid use and a sedentary lifestyle; both predispose to risk factors implicated in NAFLD. As such we hypothesised a link between asthma and NAFLD, and a possible under detection of NAFLD amongst patients with severe asthma.
Methods We audited the investigation and management of NAFLD amongst patients under the care of the Difficult Asthma Team at the Royal Brompton Hospital. We conducted a retrospective study of patients who were entered into the National Asthma Database following investigations under the Difficult Asthma Protocol (DAP) between 2007 and 2011. The following were included: Age at diagnosis, liver function (at initial assessment and most recent), liver imaging, glucose and lipids at initial investigation, and medication history.
Results 209 subjects were included in the audit, all of whom entered into the National Asthma Database between 2007 and 2011. Mean age was 45 at presentation to RBH.
Abnormal Liver Function 20% (n = 41) patients had abnormal liver function tests either at first presentation to RBH or on their most recent blood tests. Only 14 (34%) were further investigated with liver imaging. Of those with deranged liver function who were imaged, 79% (n = 11) had radiological evidence of NAFLD.
Management of patients with confirmed NAFLD Of the patients with confirmed NAFLD only 27% (n = 3) had their fasting lipids and glucose measured. 18% (n = 2) were prescribed a statin and a similar number were prescribed metformin.
Asthma medications of patients subsequently diagnosed with NAFLD 81% of patients were prescribed aminophylline. 54% were prescribed montelukast and 81% patients were prescribed oral corticosteroids. 36% of patients were treated with omalizumab (anti-IgE).
Conclusion Amongst our cohort of wevere asthmatics a substantial proportion have deranged liver function. Of those with abnormal LFT who underwent imaging, a high proportion (79%) had radiological evidence of NAFLD. However 66% of patients with deranged LFT did not proceed to liver imaging. This suggests that NAFLD is currently under diagnosed and managed in this patient population
Disclosure of Interest None Declared
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