Abstract
ABSTRACTHuman immunodeficiency virus (HIV) is associated with increased risk for chronic obstructive pulmonary disease (COPD); yet substantial under-recognition of COPD exists. We administered a patient-completed, physician-reviewed COPD screening tool in an outpatient HIV clinic to determine whether screening is feasible or possible. Patients attending nonacute, routine HIV care visits were provided a brief COPD screening tool, which included three questions focused on age, respiratory symptoms, and smoking history. Providers were given completed forms for review and ordered spirometry at their discretion. Forms and medical records were subsequently reviewed to determine completion and results of spirometry testing. Of the 1,510 patients screened during the study period, 968 (64%) forms were completed. After excluding 79 incomplete forms, 889 (92%) unique patient forms were included in this analysis. Among these, 204 (23%) met criteria for spirometry referral, among whom physicians ordered spirometry in 64 (31%). At 6 months following study completion, 19 (30%) of the patients referred for spirometry had the test completed, with 5 (26%) demonstrating airflow obstruction. Nearly one out of four HIV patients met indication for screening spirometry and roughly one out of four undergoing spirometry had COPD. Critical drop-offs in the screening and diagnostic process occurred at questionnaire completion and spirometry ordering. Interventions tailored to these critical steps could improve the yield from COPD screening and help to optimize the identification of COPD in high-risk HIV-infected populations. COPD screening in a clinic focused on longitudinal HIV care can effectively identify COPD among those completing the screening continuum.
Highlights
Human immunodeficiency virus (HIV) infection is increasingly recognized as a chronic illness
We documented that a majority of HIV-infected participants with obstructive lung disease has not been previously diagnosed by a provider [8]
Of the remaining 140 patients who met indications for spirometry yet spirometry was not ordered, the most common reason for spirometry deferral was left blank (n = 63, 45%). Among those for whom a deferral reason was listed (n = 77), the most common deferral reasons included a known diagnosis of chronic obstructive pulmonary disease (COPD) (n = 29, 38%), presence of an acute medical issue (n = 13, 17%), inappropriate testing as per the visit provider (n = 11, 14%), or prior Pulmonary Function Test (PFT) order or performance (n = 11, 14%)
Summary
Human immunodeficiency virus (HIV) infection is increasingly recognized as a chronic illness. With HIV-infected patients living longer, there has been a shift in morbidity and mortality to noninfectious conditions [1, 2]. Guidelines for the care of HIV-infected patients have evolved to include recommendations regarding screening and managing co-morbid conditions such as dyslipidaemia, insulin resistance, coronary heart disease, renal disease, and malignancies [6]. HIV has been shown to be an independent risk factor for chronic obstructive pulmonary disease (COPD), yet screening guidelines for COPD are lacking for this population [7, 8]. We documented that a majority of HIV-infected participants with obstructive lung disease has not been previously diagnosed by a provider [8]
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