Screening for Chronic Obstructive Pulmonary Disease (COPD) in an Urban HIV Clinic: A Pilot Study.
Increased smoking and a detrimental response to tobacco smoke in the lungs of HIV/AIDS patients result in an increased risk for COPD. We aimed to determine the predictive value of a COPD screening strategy validated in the general population and to identify HIV-related factors associated with decreased lung function. Subjects at least 35 years of age at an HIV clinic in New York City completed a COPD screening questionnaire and peak flow measurement. Those with abnormal results and a random one-third of normal screens had spirometry. 235 individuals were included and 89 completed spirometry. Eleven (12%) had undiagnosed airway obstruction and 5 had COPD. A combination of a positive questionnaire and abnormal peak flow yielded a sensitivity of 20% (specificity 93%) for detection of COPD. Peak flow alone had a sensitivity of 80% (specificity 80%). Abnormal peak flow was associated with an AIDS diagnosis (p=0.04), lower nadir (p=0.001), and current CD4 counts (p=0.001). Nadir CD4 remained associated in multivariate analysis (p=0.05). Decreased FEV1 (<80% predicted) was associated with lower CD4 count nadir (p=0.04) and detectable current HIV viral load (p=0.01) in multivariate analysis. Questionnaire and peak flow together had low sensitivity, but abnormal peak flow shows potential as a screening tool for COPD in HIV/AIDS. These data suggest that lung function may be influenced by HIV-related factors.
1 Divisions of Infectious Disease and Hospital Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health , Madison, Wisconsin.
Daniel K
DK
Shirley
Robert J
RJ
Kaner
Marshall J
MJ
Glesby
D000328:Adult; D000368:Aged; D000554:Ambulatory Care Facilities; D005260:Female; D005541:Forced Expiratory Volume; D015658:HIV Infections / Q000453:epidemiology; D006801:Humans; D008168:Lung / Q000503:physiopathology; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D009519:New York City; D010366:Peak Expiratory Flow Rate; D010865:Pilot Projects; D011237:Predictive Value of Tests; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology; D013147:Spirometry; D011795:Surveys and Questionnaires