Prevalence and risk factors for unrecognized obstructive lung disease among urban drug users
M Bradley Drummond1, Gregory D Kirk1,2, Jacquie Astemborski2, Meredith C McCormack1, Mariah M Marshall2, Shruti H Mehta2, Robert A Wise1, Christian A Merlo1
1Department of Medicine, School of Medicine, 2Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
Background: Obstructive lung disease (OLD) is frequently unrecognized and undertreated. Urban drug users are at higher risk for OLD due to race, behavioral, and socioeconomic characteristics, yet little data exist on prevalence and risk factors associated with unrecognized OLD in this population.
Objective: The objective of this study is to determine the prevalence of unrecognized OLD in an urban population and identify the characteristics associated with lack of physician-diagnosed OLD.
Design: Cross-sectional analysis from the Acquired Immunodeficiency Syndrome Linked to the Intravenous Experience (ALIVE) study, an observational study of current and former injection drug users in Baltimore, Maryland, USA.
Participants: All participants with spirometry-defined airflow obstruction were stratified by the presence or absence of physician diagnosis of OLD.
Main measures: Using cross-sectional demographic, clinical, and spirometric measurements, multivariable regression models were generated to identify factors independently associated with unrecognized OLD.
Key results: Of the 1083 participants evaluated in the ALIVE lung substudy, 176 (16.3%) met spirometric criteria for OLD. Of those, only 88 (50%) had a physician diagnosis of OLD. The prevalence of unrecognized OLD decreased as severity of airflow obstruction increased. Factors independently associated with unrecognized OLD were absence of respiratory symptoms (prevalence ratio [PR], 1.70; 95% confidence interval [CI]: 1.29–2.23; P < 0.01) and less severe dyspnea (PR, 0.83; 95% CI: 0.72–0.96, per point increase in dyspnea scale; P = 0.01). In the subset of human immunodeficiency virus (HIV)–infected participants, the use of antiretroviral therapy (ART) was independently associated with an increased prevalence of unrecognized OLD (PR, 1.93; 95% CI: 1.05–3.56; P = 0.03).
Conclusions: In a cohort of current and former urban drug users, OLD is substantially underrecognized and associated with lack of respiratory symptoms. Relying on the presence of respiratory symptoms as a trigger to perform spirometry may result in a substantial underdiagnosis of OLD in this population. HIV-infected individuals receiving ART are a population particularly vulnerable to unrecognized OLD.
Keywords: obstructive lung disease, human immunodeficiency virus infection, COPD, asthma, spirometry
This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.Download Article [PDF] View Full Text [HTML][Machine readable]
Readers of this article also read:
Nanda SS, An SSA, Yi DK
Published Date: 25 August 2015
Sangani RG, Ghio AJ, Parker JE
Published Date: 2 May 2015
Bledsoe JR, Christiani DC, Kradin RL
Published Date: 19 December 2014
Esquinas AM, Siscaro G, Clini EM
Published Date: 27 May 2013
Severity of COPD at initial spirometry-confirmed diagnosis: data from medical charts and administrative claims
Mapel DW, Dalal AA, Blanchette CM, Petersen H, Ferguson GT
Published Date: 9 November 2011
Sims MW, Panettieri, Jr. RA
Published Date: 16 September 2011
Pomares X, Montón C, Espasa M, Casabon J, Monsó E, Gallego M
Published Date: 6 September 2011
Disability related to COPD tool (DIRECT): towards an assessment of COPD-related disability in routine practice
Aguilaniu B, Gonzalez-Bermejo J, Regnault A, Dias Barbosa C, Arnould B, Mueser M, Granet G, Bonnefoy M, Similowski T
Published Date: 5 July 2011
Value of procalcitonin, C-reactive protein, and neopterin in exacerbations of chronic obstructive pulmonary disease
Alicia Lacoma, Cristina Prat, Felipe Andreo, et al
Published Date: 28 February 2011
Tanja Grzetic-Romcevic, Boris Devcic, Silvana Sonc,
Published Date: 10 February 2011