COPD and Dilantin

I’ve had epilepsy for about fifteen years now, and I use Dilantin to effectively control all grand mal seizures (my partial seizures are controlled with Lamictal). A few years ago, I was diagnosed with COPD, only able to expel barely 60% of my lung capacity. When I asked my doctor why, being a non-smoker, I would get COPD, he gestured to my stomach, saying that the extra thirty pounds I lug around may prevent my lungs from filling fully. More recently, I finally got chest x-rays and was just told over the phone that they indicate inflated lungs, which I guess is one of the characteristics of COPD; however, it seems to me to contradict the extra weight hypothesis.

So in my research, I come across this article at Wikipedia about Alpha 1-antitrypsin deficiency, which can lead to COPD. According to the article, Alpha 1-antitrypsin is produced in the liver. From what I have read, Dilantin can have an adverse effect on the liver. The link may be tenuous, but I’m wondering, is it possible all the same?

The thing is, I want to know why I have COPD, assuming that the overweight hypothesis is incorrect, and I have a feeling that my two main problems, epilepsy and COPD, are related somehow…

While it is true that Dilantin can have adverse effects on the liver, I think it’s highly unlikley that there’s a relationship between your use of it and the COPD (especially via alpha-1-antitrypsin). I say this because the nature of Dilantin-induced liver diseases would not be expected to affect alpha-1-antitrypsin and also because COPD due to alpha-1-antitrypsin deficiency tends to be severe and have unique characteristics (eg. part of lungs that are involved).

A more likely explanation might be found in your being overweight. In particular, obesity is associated with gastroesophageal reflux disease (GERD) and the latter may often lead to symptoms which very much resemble COPD or asthma.

Here is a typical reference on the association.

Other possiblities include seizure-induced episodes of aspiration (i.e. inhalation of stomach contents around the time of a seizure) which might look like COPD, or obesity-associated sleep apnea which might also have some symptom overlap with COPD.

BTW, in terms of dilantin leading to COPD, but not that I believe it is widely applicable, there is at least one article purporting to show a benefit of dilantin in asthma (hence, by extension, suggesting that dilantin should be of benefit COPD).