Current Research in Respiratory Care

by U.S. Medicine

May 20, 2011

Rates of Respiratory Diseases in HIV-Infected Veterans

Chronic obstructive pulmonary disease, lung cancer, pulmonary hypertension and pulmonary fibrosis, as well as pulmonary infections, are more likely among HIV-infected patients than with uninfected patients, a recent study has suggested.

The study, conducted with data from the Veterans Aging Cohort Study Virtual Cohort, examined the incidence of pulmonary diseases in 33,420 HIV-infected veterans and 66,840 age, sex, race and ethnicity, and site-matched HIV-uninfected veterans.

“Our study supports the likelihood that as HIV-infected patients age, the burden of many infectious and noninfectious pulmonary diseases will increase,” the researchers wrote in the study. “We found that age is an important risk factor for many pulmonary diseases among HIV-infected patients. We also found that the relative incidence rate comparing the HIV-infected and uninfected patients generally decreased with advancing age. One explanation for this narrowing relative incidence may be a competing risk for death among the HIV-infected patients resulting in misleadingly low incidence rates in older patients when compared with HIV-uninfected patients.”

The two most common pulmonary diseases found were bacterial pneumonia and chronic obstructive pulmonary disease, while opportunistic pneumonias were less common.

According to the study researchers, while pulmonary diseases have been among the most common complications of HIV infection, the spectrum of infectious and noninfectious pulmonary disease has not been assessed in the current combination antiretroviral therapy era.

“These data suggest that there may be a shift in the epidemiology of pulmonary diseases afflicting HIV-infected patients in the current era with a significant burden of traditional non–HIV-associated pulmonary diseases, many of which are associated with aging,” they wrote in their findings.

The study, “HIV infection and risk for incident pulmonary diseases in the combination antiretroviral therapy era,” was published in the February 2011 issue of the American Journal of Respiratory Critical Care Medicine.

Understanding the reasons for the underuse of pneumococcal vaccination by community-dwelling, older African Americans

In this study, researchers sought to understand why pneumococcal vaccination is underused in Medicare-eligible older African Americans. Study participants consisted of 795 pairs of community-dwelling Medicare-eligible African American and white adults aged 65 and older.

The study authors found that pneumococcal vaccination rates were 22% for African Americans and 28% for whites. “This association remained significant despite adjustment for sociodemographic and clinical confounders, including education, income, chronic obstructive pulmonary disease and prior pneumonia, but the association was no longer significant after additional adjustment for the receipt of influenza vaccination,” according to the study abstract. “Receipt of influenza vaccination was associated with higher odds of receiving pneumococcal vaccination, and the association between race and pneumococcal vaccination lost significance when adjusted for influenza vaccination alone.”

The authors concluded that the association between getting influenza and pneumococcal vaccinations suggest that patient and provider attitudes toward vaccination, rather than traditional confounders such as education and income, may help explain why pneumococcal vaccination in older African Americans is underused.

Source: Journal of the American Geriatrics Society. 2010 Dec;58(12):2323-8. doi: 10.1111/j.1532-5415.2010.03181.x.

Effects of pulmonary rehabilitation on activity levels in patients with chronic obstructive pulmonary disease.

According to the study abstract, researchers sought to determine whether patients with chronic obstructive pulmonary disease (COPD) increase physical activity immediately after eight weeks of pulmonary rehabilitation (PR). The activity levels in patients with COPD were also compared with those in healthy controls.

Consecutive patients with COPD and eight aged-matched controls were studied. Their activity was monitored with a triaxial accelerometer for five days before and after PR. Their activity was expressed as vector magnitude units (VMU) per minute and time spent at VMU above 250 and 500, respectively.

Overall, activity was significantly less in patients with COPD compared with that in controls. After PR, overall VMU activity was not significantly increased. Increases in activity levels after PR did not correlate with improvements in exercise performance, quality of life, or quadriceps strength.

Despite significant improvements in exercise capacity and quality of life after PR, the researchers concluded this did not translate into a significant increase in activity level.

Source: Journal of Cardiopulmonary Rehabilitation and Prevention. 2011 Jan-Feb;31(1):52-9.

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