Cross sectional analysis of respiratory symptoms in an injection drug user cohort

The impact of obstructive lung disease and HIV

M. Bradley Drummond, Gregory D Kirk, Erin P. Ricketts, Meredith McCormack, J. Christian Hague, John F. McDyer, Shruti Hemendra Mehta, Eric A. Engels, Robert A Wise, Christian Merlo

Research output: Contribution to journalArticle

Abstract

Background: Injection drug use is associated with an increased risk of human immunodeficiency virus (HIV) infection and with obstructive lung diseases (OLD). Understanding how HIV and OLD may impact respiratory symptoms among injection drug users (IDUs) is important to adequately care for this high-risk population. We characterized the independent and joint effects of HIV and OLD on respiratory symptoms of a cohort of inner-city IDUs.Methods: Demographics, risk behavior and spirometric measurements were collected from a cross-sectional analysis of the Acquired Immunodeficiency Syndrome Link to the IntraVenous Experience study, an observational cohort of IDUs followed in Baltimore, MD since 1988. Participants completed a modified American Thoracic Society respiratory questionnaire and the Medical Research Council (MRC) dyspnea score to assess respiratory symptoms of cough, phlegm, wheezing and dyspnea.Results: Of 974 participants, 835 (86%) were current smokers and 288 (29.6%) were HIV-infected. The prevalence of OLD (FEV1/FVC ≤ 0.70) was 15.5%, and did not differ by HIV status. OLD, but not HIV, was associated with increased frequency of reported respiratory symptoms. There was a combined effect of OLD and HIV on worsening of MRC scores. OLD and HIV were independently associated with an increased odds of reporting an MRC ≥ 2 (OR 1.83 [95%CI 1.23-2.73] and 1.50 [95%CI 1.08-2.09], respectively). COPD, but not HIV, was independently associated with reporting an MRC ≥ 3 (OR 2.25 [95%CI 1.43-3.54] and 1.29 [95%CI 0.87-1.91], respectively).Conclusions: While HIV does not worsen cough, phlegm or wheezing, HIV significantly increases moderate but not severe dyspnea in individuals of similar OLD status. Incorporating the MRC score into routine evaluation of IDUs at risk for OLD and HIV provides better assessment than cough, phlegm and wheezing alone.

Original languageEnglish (US)
Article number27
JournalBMC Pulmonary Medicine
Volume10
DOIs
StatePublished - May 11 2010

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Obstructive Lung Diseases
Drug Users
Cross-Sectional Studies
HIV
Injections
Biomedical Research
Respiratory Sounds
Cough
Dyspnea
Baltimore
Virus Diseases
Risk-Taking
Chronic Obstructive Pulmonary Disease
Observational Studies
Acquired Immunodeficiency Syndrome
Cohort Studies

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Cross sectional analysis of respiratory symptoms in an injection drug user cohort : The impact of obstructive lung disease and HIV. / Drummond, M. Bradley; Kirk, Gregory D; Ricketts, Erin P.; McCormack, Meredith; Hague, J. Christian; McDyer, John F.; Mehta, Shruti Hemendra; Engels, Eric A.; Wise, Robert A; Merlo, Christian.

In: BMC Pulmonary Medicine, Vol. 10, 27, 11.05.2010.

Research output: Contribution to journalArticle

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abstract = "Background: Injection drug use is associated with an increased risk of human immunodeficiency virus (HIV) infection and with obstructive lung diseases (OLD). Understanding how HIV and OLD may impact respiratory symptoms among injection drug users (IDUs) is important to adequately care for this high-risk population. We characterized the independent and joint effects of HIV and OLD on respiratory symptoms of a cohort of inner-city IDUs.Methods: Demographics, risk behavior and spirometric measurements were collected from a cross-sectional analysis of the Acquired Immunodeficiency Syndrome Link to the IntraVenous Experience study, an observational cohort of IDUs followed in Baltimore, MD since 1988. Participants completed a modified American Thoracic Society respiratory questionnaire and the Medical Research Council (MRC) dyspnea score to assess respiratory symptoms of cough, phlegm, wheezing and dyspnea.Results: Of 974 participants, 835 (86{\%}) were current smokers and 288 (29.6{\%}) were HIV-infected. The prevalence of OLD (FEV1/FVC ≤ 0.70) was 15.5{\%}, and did not differ by HIV status. OLD, but not HIV, was associated with increased frequency of reported respiratory symptoms. There was a combined effect of OLD and HIV on worsening of MRC scores. OLD and HIV were independently associated with an increased odds of reporting an MRC ≥ 2 (OR 1.83 [95{\%}CI 1.23-2.73] and 1.50 [95{\%}CI 1.08-2.09], respectively). COPD, but not HIV, was independently associated with reporting an MRC ≥ 3 (OR 2.25 [95{\%}CI 1.43-3.54] and 1.29 [95{\%}CI 0.87-1.91], respectively).Conclusions: While HIV does not worsen cough, phlegm or wheezing, HIV significantly increases moderate but not severe dyspnea in individuals of similar OLD status. Incorporating the MRC score into routine evaluation of IDUs at risk for OLD and HIV provides better assessment than cough, phlegm and wheezing alone.",
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T2 - The impact of obstructive lung disease and HIV

AU - Drummond, M. Bradley

AU - Kirk, Gregory D

AU - Ricketts, Erin P.

AU - McCormack, Meredith

AU - Hague, J. Christian

AU - McDyer, John F.

AU - Mehta, Shruti Hemendra

AU - Engels, Eric A.

AU - Wise, Robert A

AU - Merlo, Christian

PY - 2010/5/11

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N2 - Background: Injection drug use is associated with an increased risk of human immunodeficiency virus (HIV) infection and with obstructive lung diseases (OLD). Understanding how HIV and OLD may impact respiratory symptoms among injection drug users (IDUs) is important to adequately care for this high-risk population. We characterized the independent and joint effects of HIV and OLD on respiratory symptoms of a cohort of inner-city IDUs.Methods: Demographics, risk behavior and spirometric measurements were collected from a cross-sectional analysis of the Acquired Immunodeficiency Syndrome Link to the IntraVenous Experience study, an observational cohort of IDUs followed in Baltimore, MD since 1988. Participants completed a modified American Thoracic Society respiratory questionnaire and the Medical Research Council (MRC) dyspnea score to assess respiratory symptoms of cough, phlegm, wheezing and dyspnea.Results: Of 974 participants, 835 (86%) were current smokers and 288 (29.6%) were HIV-infected. The prevalence of OLD (FEV1/FVC ≤ 0.70) was 15.5%, and did not differ by HIV status. OLD, but not HIV, was associated with increased frequency of reported respiratory symptoms. There was a combined effect of OLD and HIV on worsening of MRC scores. OLD and HIV were independently associated with an increased odds of reporting an MRC ≥ 2 (OR 1.83 [95%CI 1.23-2.73] and 1.50 [95%CI 1.08-2.09], respectively). COPD, but not HIV, was independently associated with reporting an MRC ≥ 3 (OR 2.25 [95%CI 1.43-3.54] and 1.29 [95%CI 0.87-1.91], respectively).Conclusions: While HIV does not worsen cough, phlegm or wheezing, HIV significantly increases moderate but not severe dyspnea in individuals of similar OLD status. Incorporating the MRC score into routine evaluation of IDUs at risk for OLD and HIV provides better assessment than cough, phlegm and wheezing alone.

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