Abstract
Introduction: Many heroin smokers both develop and die from premature severe COPD. Their lack of engagement with conventional health services contributes to late diagnosis. Liverpool Clinical Commissioning Group have funded spirometry at community based substance misuse clinics to screen 1100 heroin smokers for COPD in order to reducing health inequality.
Methods: Respiratory physiologists will be present at one or more drug keyworker appointments for all 1100 clients managed in shared care with Addaction in Liverpool for six months from December 2015. They will record a detailed tobacco and drug smoking history, MRC dyspnea score, CAT score and spirometry. Clients found to have COPD are informed of the diagnosis and referred their GPs for management.
Results: 184 clients have completed the test, 133(72%) male, mean age 47 (SD 6) years. 184 (100 %) are current/ex tobacco smokers, 180 (98%) heroin smokers (mean 22 years smoked), 158 (86%) have smoked cannabis and 160 (87%) are current or ex crack smokers.
91/184 (49%) clients had post-bronchodilator values in keeping with COPD (mean (SD): FEV1 2.54 l (0.97 l ), 70%(28.5) predicted, FEV1/FVC 0.55 (13), MRC 3 (1.4), CAT score 22 (9.8)).
A further 22 (12%) had results compatible with asthma (mean FEV1 reversibility 528mls, 20%). Only 62 (34%) had normal spirometry.
Conclusions: Hard to reach groups can be reached. Healthcare should be co-located to the point to at which they reliably access the system. The prevalence of COPD was high at the substance misuse clinic. The majority of those diagnosed with COPD were not aware they had it (47 pts, 52%). Early diagnosis in this at risk group may allow a reduction in the rate of decline and future healthcare utilization.
- Copyright ©the authors 2016
