Abnormal Airway Function in Individuals with the Acquired Immunodeficiency Syndrome: Relation of Abnormal Airways Function to Clinical Events
Relation of Abnormal Airways Function to Clinical Events
We examined the temporal relationship of PFT results to episodes of Pneumocystis carinii pneumonia (PCP) and the presence of systemic Kaposis sarcoma (KS) for possible clues to the pathogenesis of airway dysfunction. Among the 99 AIDS patients reported here, 54 percent had developed PCE while 29 percent had developed systemic KS within three months prior to testing. Eight of 18 (44 percent) cases with KS alone and nine of 42 (21 percent) cases with PCP alone had evidence of airway dysfunction. Among individuals with coexistent PCP and KS, abnormal airway function was present in seven of 11 (63.6 percent) cases. Fifteen of 29 (52 percent) individuals who had KS with or without PCP and 16 of53 (30 percent) individuals who had PCP with or without KS had airway dysfunction. Twenty of 28 (71 percent) individuals with AIDS had abnormal tests of airway function that were not associated with PCP or KS.
Of the 29 individuals with systemic KS analyzed in this study, only four had endobronchial KS visualized at bronchoscopy, while one additional patient had chest x-ray findings suggestive of pulmonary involvement with KS. There was a significant association between the presence of symptoms such as cough, wheeze, and chest tightness, and the occurrence of abnormal tests of airway function (Table 1). Twenty-two of32 (68.8 percent) symptomatic individuals had abnormal function as compared with 18 of 67 (26.9 percent) AIDS patients who did not have such symptoms. Bronchodilator therapy was instituted in 24 of the symptomatic individuals, with clinical improvement in 20 cases.
This study demonstrates the frequent occurrence of abnormal airway function among individuals with AIDS. In this sample, we found that 44 percent of subjects had either abnormally low forced expiratory flow rates or a significant response to inhaled bronchodilator. Abnormal function was more prevalent among individuals with systemic KS than it was among those with the diagnosis of PCI? but was most common among those with neither PCP nor KS.
Table 1—Association of Respiratory Symptoms and Abnormal Airway Function Among Individuals with AIDS