Chronic Lung Disease

PWH have faster lung function decline than the background population. Age and smoking are the main risk factors, but even never-smokers have faster lung function decline than never-smokers in the background population.*

Chronic Lung Disease.png

There are 3 lifesaving interventions in COPD:
1. Smoking cessation
2. Chronic oxygen when stable (non-exacerbated) resting SpO2 ≤ 88% (or PaO2 ≤ 55 mmHg)
3. Non-invasive ventilation (NIV) in individuals with persistent hypercapnia

* Thudium, Ronit, Afzal et al. Faster lung function decline in people living with HIV despite adequate treatment: a longitudinal matched cohort study: COCOMO, INSIGHT START Pulmonary Substudy and CGPS Study Groups. Thorax. 2023 Jan 13;thoraxjnl-2022-218910. PMID: 36639241 Verboeket, Boyd, Wit, et al. Changes in lung function among treated HIV-positive and HIV-negative individuals: analysis of the prospective AGEhIV cohort study. Lancet Healthy Longev. 2021 Apr;2(4):e202-e211. PMID: 36098121

Pharmacological treatment of COPD(v)(vi)

Pharmacological treatment of COPD.png

Eos: eosinophils
LABA: Long Acting Beta2 Agonist
LAMA: Long Acting AntiMuscarinic
ICS: Inhaled Corticosteroid
SABA: Short Acting Beta2 Agonist
Reassess and adjust regularly according to the response to treatment in terms of symptoms and/or acute exacerbations. Adapted from GOLD 2023 (

  1. Risk assessment for spirometry should be undertaken in the setting of COVID-19
  2. Based on expert opinion, also consider interstitial lung disease, CT scan may help to identify people with interstitial lung disease and lung cancer
  3. Assessment of either dyspnoea using mMRC, see or symptoms using CAT™, see and history of exacerbations (including prior hospitalisations)
  4. COPD may have significant extra-pulmonary (systemic effects) including weight loss, nutritional abnormalities, frailty and skeletal mass dysfunction, and is almost invariably associated with one or more chronic comorbidities, mainly cardiovascular, respiratory and metabolic
  5. Each pharmacological treatment should be individualised and guided by the severity of symptoms, risk of exacerbations, adverse effects, co-morbidities, drug availability and cost, and the individual’s response, preference and ability to use various drug delivery devices. Inhaler technique needs to be assessed regularly. Long-term use of high dose ICS and/or use of oral glucocorticoids has no evidence of benefits in COPD and increase the risk of pneumonia. The addition of medium dose ICS to LABA or LAMA or LABA/LAMA is recommended in individuals with history of frequent exacerbations and/or asthma and/or eosinophilia (> 300/µL), or in individuals not adequately controlled by LAMA/LABA combinations. ICS should be avoided in subjects with eosinopenia (< 1%). Antibiotics should be used to treat acute exacerbation or in case of high CRP and purulent sputum (PCT is a more questionable biomarker). Long-term azithromycin may also be considered in non-smokers, not well controlled with maximal inhaled drug dosage
  6. LAMA/LABA/ICS are now available in a fixed dose combination. This drug combination improves clinical control of COPD and increases life expectancy.
With the exception of low dose beclometasone, do not use inhaled glucocorticoids with boosted ART regimens, see Drug-drug Interactions between Corticosteroids and ARVs.

Influenza, SARS-CoV-2 and pneumococcal vaccination decrease rates of lower respiratory tract infections, see Vaccination 
Pertussis vaccination is also suggested in people with COPD