RT Journal Article SR Electronic T1 Prevalence of COPD in heroin smokers screened at substance misuse clinics JF European Respiratory Journal JO Eur Respir J FD European Respiratory Society SP PA4178 DO 10.1183/13993003.congress-2016.PA4178 VO 48 IS suppl 60 A1 Jennifer Furlong A1 Rob Peat A1 Ryan Young A1 Tara Byrne A1 Doreen Russell A1 Tristan Elkin A1 Sandra Oelbaum A1 Hassan Burhan A1 Paul Walker A1 Sue Renwick YR 2016 UL http://erj.ersjournals.com/content/48/suppl_60/PA4178.abstract AB 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.