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Aerosol pentamidine-induced bronchoconstriction. Predictive factors and preventive therapy
J Quieffin1, J Hunter, M T Schechter
1St. Paul's Hospital, University of British Columbia, Vancouver, Canada.
Chest
|September 1, 1991
Summary
Aerosol pentamidine caused bronchoconstriction in 34% of HIV patients, not predicted by methacholine response. Salbutamol and ipratropium bromide effectively prevented this, while cromoglycate was less effective.
Area of Science:
- Pulmonology
- Infectious Diseases
- Pharmacology
Background:
- Aerosol pentamidine (AP) is a key prophylactic treatment for Pneumocystis pneumonia (PCP) in HIV-infected individuals.
- Bronchoconstriction is a potential adverse effect of AP administration.
- Understanding the predictors and management of AP-induced bronchoconstriction is crucial for patient care.
Purpose of the Study:
- To determine the frequency of aerosol pentamidine-induced bronchoconstriction.
- To investigate the relationship between AP-induced bronchoconstriction and non-specific airway responsiveness.
- To evaluate the efficacy of salbutamol, ipratropium bromide, and sodium cromoglycate in preventing AP-induced bronchoconstriction.
Main Methods:
- Fifty-three HIV-infected individuals initiating prophylactic AP were enrolled.
- Simple spirometry assessed FEV1 changes 10 minutes after AP administration.
- Methacholine challenge tested airway responsiveness; subjects with significant FEV1 decrease underwent further testing with bronchodilators.
Main Results:
- 34% of subjects experienced a FEV1 decrease ≥10% after AP.
- AP-induced bronchoconstriction was not accurately predicted by methacholine challenge results.
- Salbutamol and ipratropium bromide significantly attenuated AP-induced bronchoconstriction (median delta FEV1: 1.0% and 0.8%), while sodium cromoglycate showed partial efficacy (median delta FEV1: -9.6%).
Conclusions:
- A significant proportion of HIV patients develop bronchoconstriction with aerosol pentamidine.
- Non-specific airway hyperresponsiveness does not reliably predict this reaction.
- Inhaled short-acting beta-agonists (salbutamol) and anticholinergics (ipratropium bromide) are effective in preventing aerosol pentamidine-induced bronchoconstriction.