Small airways dysfunction in patients with AIDS and Pneumocystis carinii pneumonia.
OBJECTIVE
Abnormalities of small airways function may have clinical relevance in AIDS patients with Pneumocystis carinii pneumonia (PCP) since obstructive dysfunction at alveolar levels may impede delivery of aerosolized medication. This study was designed to determine if small airways dysfunction is present in AIDS patients with PCP despite normal standard spirometric results.


METHODS
Ten AIDS patients with documented PCP and no other identifiable pulmonary infection without respiratory failure and with a normal FEV1/FVC ratio were evaluated.


METHODS
Small airways function was assessed by the FEF75 and the change in maximum expiratory flow while breathing a helium-oxygen mixture compared to room air (delta Vmax50%) with and without bronchodilator administration. Testing was done before and after completion of intravenous therapy for PCP.


RESULTS
Despite absence of cough or wheezing at the time of evaluation and a normal FEV1/FVC ratio, significant obstructive dysfunction of the small airways was demonstrated in 6 of 10 patients, which improved with bronchodilators. Three weeks of intravenous therapy for PCP had no effect on these abnormalities. The degree of small airways dysfunction was greater than could be explained by smoking history alone.


CONCLUSIONS
Small airways dysfunction, which can be improved with bronchodilator administration, may be present in AIDS patients with PCP despite normal spirometry and absence of cough or wheezing. Screening for small airways dysfunction may identify patients who might benefit from bronchodilator administration prior to inhalation of aerosolized medications.
Fleischman
J K
JK
Queens Hospital Center, Mount Sinai School of Medicine, New York, NY, USA.
Greenberg
H
H
Web
A
A
D017088:AIDS-Related Opportunistic Infections / Q000150:complications*; D000328:Adult; D000336:Aerosols; D019380:Anti-HIV Agents / Q000008:administration & dosage; D001993:Bronchodilator Agents / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008171:Lung Diseases / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology*; D008176:Lung Volume Measurements; D008297:Male; D008875:Middle Aged; D016720:Pneumocystis Infections / Q000150:complications* / Q000503:physiopathology; D013147:Spirometry
D000336:Aerosols; D019380:Anti-HIV Agents; D001993:Bronchodilator Agents