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Momen M. Wahidi, MD, MBA, FCCP; Sally Y. Barbour, PharmD; Gerard A. Silvestri, MD, FCCP
Author and Funding Information

From the Department of Medicine (Dr Wahidi) and the Department of Pharmacy (Dr Barbour), Duke University Medical Center; and the Medical University of South Carolina (Dr Silvestri).

Correspondence to: Momen M. Wahidi, MD, MBA, FCCP, Department of Internal Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University Medical Center, Box 3683, Durham, NC 27710; e-mail: momen.wahidi@duke.edu


Financial/nonfinancial disclosures: The authors have reported to CHEST the following conflicts of interest: Dr Wahidi was an investigator on the multicenter trial of Fospropofol. Dr Silvestri was an investigator on the multicenter trial of Fospropofol; he was a recipient of grant funding from Olympus America and MGI Pharma for a project assessing fospropofol for bronchoscopy and from Allegro Diagnostics Corp for assessing malignancy in patients with abnormal chest radiographs. Dr Barbour has reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2012 American College of Chest Physicians


Chest. 2012;141(4):1125-1126. doi:10.1378/chest.12-0160
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To the Editor:

We appreciate the comments of Dr José and colleagues about our recent consensus statement in CHEST1 and thank them for bringing attention to HIV disease, wherein great advances have been accomplished. Continuous attention to this patient population is indeed essential.

Our article attempted to address the major issues on the use of topical anesthesia, analgesia, and sedation during bronchoscopy. Therefore, it was beyond the scope of our effort to address all possible interactions of medications with various disease states.

Our segment on benzodiazepines specifically mentioned the need for higher doses of midazolam in “HIV-infected patients with history of drug dependence” and did not advocate it in all patients with HIV. We do agree that precautions should be taken when using benzodiazepines in patients with HIV receiving antiretroviral therapy, as these medications are known to inhibit the cytochrome P450 enzyme 3A4, potentially leading to excessive sedation.2,3

Our consensus statement can serve as a general platform to guide administration of sedation to patients undergoing bronchoscopy. Optimal and safe sedation requires physicians to tailor regimens to individual patients after careful assessment of comorbidities, medication profile, and procedural needs.

Wahidi MM, Jain P, Jantz M, et al. American College of Chest Physicians consensus statement on the use of topical anesthesia, analgesia, and sedation during flexible bronchoscopy in adult patients. Chest. 2011;1405:1342-1350 [CrossRef] [PubMed]
 
Dresser GK, Spence JD, Bailey DG. Pharmacokinetic-pharmacodynamic consequences and clinical relevance of cytochrome P450 3A4 inhibition. Clin Pharmacokinet. 2000;381:41-57 [CrossRef] [PubMed]
 
Sagir A, Schmitt M, Dilger K, Häussinger D. Inhibition of cytochrome P450 3A: relevant drug interactions in gastroenterology. Digestion. 2003;681:41-48 [CrossRef] [PubMed]
 

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References

Wahidi MM, Jain P, Jantz M, et al. American College of Chest Physicians consensus statement on the use of topical anesthesia, analgesia, and sedation during flexible bronchoscopy in adult patients. Chest. 2011;1405:1342-1350 [CrossRef] [PubMed]
 
Dresser GK, Spence JD, Bailey DG. Pharmacokinetic-pharmacodynamic consequences and clinical relevance of cytochrome P450 3A4 inhibition. Clin Pharmacokinet. 2000;381:41-57 [CrossRef] [PubMed]
 
Sagir A, Schmitt M, Dilger K, Häussinger D. Inhibition of cytochrome P450 3A: relevant drug interactions in gastroenterology. Digestion. 2003;681:41-48 [CrossRef] [PubMed]
 
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