Prevalence and risk factors for unrecognized obstructive lung disease among urban drug users

Abstract

BackgroundObstructive lung disease (OLD) is frequently unrecognized and undertreated. Urban drug users are at higher risk for OLD due to race, behavioral, and socioeconomic characteristics, yet little data exist on prevalence and risk factors associated with unrecognized OLD in this population.ObjectiveThe objective of this study is to determine the prevalence of unrecognized OLD in an urban population and identify the characteristics associated with lack of physician-diagnosed OLD.DesignCross-sectional analysis from the Acquired Immunodeficiency Syndrome Linked to the Intravenous Experience (ALIVE) study, an observational study of current and former injection drug users in Baltimore, Maryland, USA.ParticipantsAll participants with spirometry-defined airflow obstruction were stratified by the presence or absence of physician diagnosis of OLD.Main measuresUsing cross-sectional demographic, clinical, and spirometric measurements, multivariable regression models were generated to identify factors independently associated with unrecognized OLD.Key resultsOf the 1083 participants evaluated in the ALIVE lung substudy, 176 (16.3%) met spirometric criteria for OLD. Of those, only 88 (50%) had a physician diagnosis of OLD. The prevalence of unrecognized OLD decreased as severity of airflow obstruction increased. Factors independently associated with unrecognized OLD were absence of respiratory symptoms (prevalence ratio [PR], 1.70; 95% confidence interval [CI]: 1.29–2.23; P < 0.01) and less severe dyspnea (PR, 0.83; 95% CI: 0.72–0.96, per point increase in dyspnea scale; P = 0.01). In the subset of human immunodeficiency virus (HIV)–infected participants, the use of antiretroviral therapy (ART) was independently associated with an increased prevalence of unrecognized OLD (PR, 1.93; 95% CI: 1.05–3.56; P = 0.03).ConclusionsIn a cohort of current and former urban drug users, OLD is substantially underrecognized and associated with lack of respiratory symptoms. Relying on the presence of respiratory symptoms as a trigger to perform spirometry may result in a substantial underdiagnosis of OLD in this population. HIV-infected individuals receiving ART are a population particularly vulnerable to unrecognized OLD.

Factors associated with abnormal spirometry among HIV-infected individuals

“…For this analysis, all HIV-infected Lung-HIV participants from the United States sites who contributed clinical and demographic data, spirometric measures, and HIV-related laboratory testing were included (see Supplemental Digital Content 1 for contributing centers and participant selection). While individual sites have previously included data on lung function in subsets of participants included in this analytical cohort,[10, 21, 24–27] prior analyses included spirometry measurements obtained at different time points during follow-up or in the context of different research objectives. Prior publications have not published on restrictive physiology patterns or compared risk factors for obstruction and restriction versus normal spirometry pattern among HIV-infected individuals.…”

Association of COPD With Risk for Pulmonary Infections Requiring Hospitalization in HIV-Infected Veterans

“…Chronic obstructive pulmonary disease (COPD) is one of the most common non-infectious pulmonary complications observed among HIV+ patients, 15–17 and occurs more frequently in this patient population than among uninfected individuals. 4,18 While COPD is strongly associated with increased CAP risk in uninfected patients, 19–23 no studies have focused on the role of COPD in the risk for CAP and other pulmonary infections amongst HIV+ patients.…”

HIV-associated obstructive lung diseases: insights and implications for the clinician

“…Notably, 50% of this cohort with spirometrically confirmed airflow obstruction had never received a physician diagnosis of obstructive lung disease; current ART use was independently associated with greater prevalence of unrecognised obstructive lung disease. 38 A combined analysis of data from two large observational cohorts of HIV-infected men and women obtained before and after widespread ART use provided insight into the potential role of ART in mitigating longitudinal COPD risk. 37 Compared with HIV-uninfected men in the Multicentre AIDS Cohort Study, HIV-infected men had a nearly three times greater risk of self-reported COPD diagnosis in the era before ART (hazard ratio [HR] 2·9, 95% CI 1·02–8·4).…”