COPD Frequently Misdiagnosed, Undiagnosed in Individuals With or Without HIV

This article is part of Pulmonology Advisor‘s coverage of the American Thoracic Society’s International Conference, taking place in San Diego, California. Our staff will report on medical research related to asthma and other respiratory conditions, conducted by experts in the field. Check back regularly for more news from ATS 2018.

SAN DIEGO — Chronic obstructive pulmonary disease (COPD) is frequently both misdiagnosed and undiagnosed similarly in individuals with and without HIV, according to research presented at the American Thoracic Society (ATS) 2018 International Conference.

Researchers conducted a secondary analysis using data from the Examinations of HIV Associated Lung Emphysema study at 4 Veterans Affairs medical centers participating in the Veterans Aging Cohort Study from 2009 to 2012.

At baseline, COPD diagnosis was defined using International Classification of Diseases, Ninth Revision (ICD-9), codes. From enrollment, COPD was spirometrically determined using postbronchodilator spirometry ratio of forced expiratory volume in 1 second to forced vital capacity <0.7 (FEV₁/FVC). Medication prescriptions were collected from Veterans Affairs electronic health records.

Researchers compared ICD-9 diagnosis with spirometry-based diagnosis of COPD and examined medication prescriptions in the year before and after enrollment. Individuals with and without HIV were compared using chi-squared testing.

A total of 170 individuals with HIV and 145 individuals without HIV were included in the analysis. Prior ICD-9 diagnosis of COPD was identified in 46 participants, and 64 participants had spirometry-defined COPD. Of the participants with an ICD-9 diagnosis of COPD, 60% did not have spirometry-defined COPD. Similarly, 73% of participants with spirometry-defined COPD lacked prior ICD-9 diagnosis of COPD. These proportions were similar by HIV status.

In participants without HIV and with an ICD-9 COPD diagnosis, only 23% were prescribed long-acting beta-agonists (LABAs), and only 5% were prescribed long-acting muscarinic antagonists (LAMAs) in the year before study enrollment.

Inhaled corticosteroids were the most common long-acting medication prescribed to both individuals with and without HIV in 1 year before vs 1 year after study enrollment (individuals with HIV, 21% vs 29%; individuals without HIV, 23% vs 27%, respectively). LABAs and LAMAs were less commonly prescribed, particularly in individuals with HIV (P =.06 for LABA). Prescription of long-acting inhalers did not appear to increase in those with spirometry-based diagnosis of COPD in the year after enrollment.

“Inappropriate [inhaled corticosteroids] use may be of particular concern in individuals [with HIV] given the increased risk for pneumonia and medication interactions. Implementation strategies to improve guideline-concordant COPD diagnosis and management are needed as patients [with HIV] are aging with increasing prevalence of comorbid COPD,” concluded the researchers.

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Reference

Zifodya JS, Triplette M, Shahrir S, et al. Diagnosis and management of COPD in HIV-infected individuals: opportunities for improvement. Presented at: American Thoracic Society 2018 International Conference; May 18-23, 2018; San Diego, CA. Abstract 6093.