Combining COPD Screening and Community Drug Services Benefits Heroin Smokers

Up to 39% of heroin smokers receiving treatment for respiratory symptoms at UK National Health Service drug centers in Liverpool, England have chronic obstructive pulmonary disease (COPD), and combining drug services with screening and respiratory treatment services produced positive feedback from the majority of these patients, according to a study published in CHEST.

In this cross-sectional study, researchers aimed to assess respiratory symptoms, COPD prevalence, health status, and drug exposure in a population of heroin smokers with airway disease who had been prescribed opiate substitution therapy. Data were obtained through Medical Research Council (MRC) and COPD Assessment Tool (CAT) questionnaires, spirometry, recorded drug exposure, and feedback provided by study participants.

Of the 1082 regular clients who were eligible, 789 agreed to participate and completed screening. A total of 35% (n=260) screened positive for COPD using forced expiratory volume in the first second of expiration/forced vital capacity <0.7, and 39% (n=293) screened positive using the lower limit of normal. Furthermore, 15% (n=112) had asthma COPD  overlap syndrome and 21% (n=155) had asthma.

In spirometry tests, patients with COPD were more breathless than those who tested normal (MRC score 3.1 vs 1.9; P <.001) and had worse health statuses (CAT score 22.9 vs 13.4; P <.001). Participants with COPD had smoked cigarettes, heroin, and crack for longer (P <.001, P <.001, and P =.03, respectively) and were more likely to be currently smoking heroin (P <.01). Feedback on the study procedures was overwhelmingly positive, with 92% of participants expressing that they were happy for their other healthcare service appointments to be combined with their drug center appointments.

The investigators concluded that screening in high-risk areas provides a good opportunity to reduce patient symptoms and risk. “Anchoring respiratory health screening to drug centre appointments delivers high completion and satisfaction and is an appropriate model for screening other hard-to-reach populations.”

Disclosures: Multiple authors reported fees from the pharmaceutical industry. Please refer to reference for a complete list of authors’ disclosures. 

Reference

Burhan H, Young R, Byrne T, et al. Screening heroin smokers attending community drug services for COPD [published online September 3, 2018]. CHEST. doi:10.1016/j.chest.2018.08.1049