About this item:

32 Views | 20 Downloads

Author Notes:

Jerry S. Zifodya, 1430 Tulane Avenue #8509, New Orleans, LA 70112 (e-mail: jzifodya@tulane.edu)

Conceptualization: Jerry Simbarashe Zifodya, Matthew Triplette, Shahida Shahrir, Kristina Crothers. Data curation: Jerry Simbarashe Zifodya, Matthew Triplette, Shahida Shahrir, Engi F. Attia, Laurence Huang, Kristina Crothers. Formal analysis: Matthew Triplette, Shahida Shahrir. Funding acquisition: Laurence Huang, Kristina Crothers. Investigation: Jerry Simbarashe Zifodya, Matthew Triplette, Shahida Shahrir, Engi F. Attia, Kathleen M. Akgun, Grant W. Soo Hoo, Maria C. Rodriguez-Barradas, Cherry Wongtrakool, Laurence Huang, Kristina Crothers. Methodology: Jerry Simbarashe Zifodya, Matthew Triplette, Shahida Shahrir, Engi F. Attia, Kathleen M. Akgun, Grant W. Soo Hoo, Maria C. Rodriguez-Barradas, Cherry Wongtrakool, Laurence Huang, Kristina Crothers. Project administration: Kristina Crothers. Resources: Laurence Huang, Kristina Crothers. Supervision: Laurence Huang, Kristina Crothers. Writing – original draft: Jerry Simbarashe Zifodya, Matthew Triplette, Kristina Crothers. Writing – review & editing: Jerry Simbarashe Zifodya, Matthew Triplette, Shahida Shahrir, Engi F. Attia, Kathleen M. Akgun, Grant W. Soo Hoo, Maria C. Rodriguez-Barradas, Cherry Wongtrakool, Laurence Huang, Kristina Crothers.

The authors have no conflicts to disclose.

Subjects:

Research Funding:

NIH: Kl2 HD043451 (JSZ), T32 HL007287 (JSZ, PIs Curtis and Glenny), K24 HL087713 (LH), R01 HL128156 (LH), U01HL142103 (KC), and R01HL090342 (KC).

Keywords:

  • bronchodilators
  • chronic obstructive pulmonary disease
  • diagnostic errors
  • HIV
  • spirometry

A cross-sectional analysis of diagnosis and management of chronic obstructive pulmonary disease in people living with HIV

Tools:

Journal Title:

MEDICINE

Volume:

Volume 100, Number 37

Publisher:

Type of Work:

Article | Final Publisher PDF

Abstract:

Chronic obstructive pulmonary disease (COPD) is common in people living with HIV (PLWH). We sought to evaluate the appropriateness of COPD diagnosis and management in PLWH, comparing results to HIV-uninfected persons. We conducted a cross-sectional analysis of Veterans enrolled in the Examinations of HIV-Associated Lung Emphysema study, in which all participants underwent spirometry at enrollment and reported respiratory symptoms on self-completed surveys. Primary outcomes were misdiagnosis and under-diagnosis of COPD, and the frequency and appropriateness of inhaler prescriptions. Misdiagnosis was defined as having an International Classification of Diseases (ICD)-9 diagnosis of COPD without spirometric airflow limitation (post-bronchodilator forced expiratory volume in 1-second [FEV1]/Forced vital capacity [FVC] < 0.7). Under-diagnosis was defined as having spirometry-defined COPD without a prior ICD-9 diagnosis. The analytic cohort included 183 PLWH and 152 HIV-uninfected participants. Of 25 PLWH with an ICD-9 diagnosis of COPD, 56% were misdiagnosed. Of 38 PLWH with spirometry-defined COPD, 71% were under-diagnosed. In PLWH under-diagnosed with COPD, 85% reported respiratory symptoms. Among PLWH with an ICD-9 COPD diagnosis as well as in those with spirometry-defined COPD, long-acting inhalers, particularly long-acting bronchodilators (both beta-agonists and muscarinic antagonists) were prescribed infrequently even in symptomatic individuals. Inhaled corticosteroids were the most frequently prescribed long-acting inhaler in PLWH (28%). Results were overall similar amongst the HIV-uninfected. COPD was frequently misdiagnosed and under-diagnosed in PLWH, similar to uninfected-veterans. Among PLWH with COPD and a likely indication for therapy, long-acting inhalers were prescribed infrequently, particularly guideline-concordant, first-line long-acting bronchodilators. Although not a first-line controller therapy for COPD, inhaled corticosteroids were prescribed more often.

Copyright information:

© 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

This is an Open Access work distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/rdf).
Export to EndNote