Among middle-aged heroin smokers, COPD is very common

  • Burhan H & al.
  • Chest
  • 1 Feb 2019

  • curated by Jenny Blair, MD
  • Clinical Essentials
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Takeaway

  • Up to half of heroin smokers had either COPD or asthma-COPD overlap in this cross-sectional study.
  • Editorial says that "a cogent case" can be made for screening spirometry in this population, even though current recommendations are that spirometry be used in symptomatic patients at risk.

Why this matters

  • Inhalation is common heroin-exposure route.
  • This study cohort is larger than previous studies of COPD prevalence among heroin smokers.

Key results

  • Mean age, 47 years.
  • 49% reported still smoking heroin; 88% were current tobacco smokers; 29% current cannabis smokers.
  • Abnormal scores on questionnaires: 
    • COPD Assessment Tool QoL questionnaire: 75%.
    • Medical Research Council Dyspnea Scale score ≥3: 50%.
  • Prevalences of:
    • COPD by FEV1/FVC
    • COPD by lower-limit-of-normal definition: 39%.
    • Asthma-COPD overlap: 15%.
    • Asthma: 21%.
  • 66% with COPD were diagnosed for the first time during study visit.

Study design

  • Cross-sectional study of heroin smokers receiving opiate substitution therapy at community drug centers in the UK (n=789; 73% participation rate).
  • During 30-minute appointments scheduled alongside methadone or buprenorphine delivery, participants underwent spirometry, completed questionnaires. 
  • Outcome: COPD prevalence. 
  • Funding: Liverpool Clinical Commissioning Group.

Limitations

  • Exposures difficult to quantify.
  • Prescribing data not available.

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