Public Health and Preventive Medicine Residency Program, University of Toronto, Toronto, Ontario, Canada.
J Urban Health. 2013 Jun;90(3):542-51. doi: 10.1007/s11524-012-9780-9.
Among inner-city populations in Canada, the use of crack cocaine by inhalation is prevalent. Crack smoking is associated with acute respiratory symptoms and complications, but less is known about chronic respiratory problems related to crack smoking. There is also a gap in the literature addressing the management of respiratory disease in primary health care among people who smoke crack. The purpose of our study was to assess the prevalence of acute and chronic respiratory symptoms among patients who smoke crack and access primary care. We conducted a pilot study among 20 patients who currently smoke crack (used within the past 30 days) and who access the "drop-in clinic" at an inner-city primary health care center. Participants completed a 20- to 30-min interviewer-administered survey and provided consent for a chart review. We collected information on respiratory-related symptoms, diagnoses, tests, medications, and specialist visits. Data were analyzed using frequency tabulations in SPSS (version 19.0). In the survey, 95 % (19/20) of the participants reported having at least one respiratory symptom in the past week. Thirteen (13/19, 68.4 %) reported these symptoms as bothersome. Chart review indicated that 12/20 (60 %) had a diagnosis of either asthma or chronic obstructive pulmonary disease (COPD), and four participants (4/20, 20 %) had a diagnosis of both asthma and COPD. Majority of the participants had been prescribed an inhaled medication (survey 16/20, 80 %; chart 12/20, 60 %). We found that 100 % (20/20) of the participants currently smoked tobacco, and 16/20 (80 %) had smoked both tobacco and marijuana prior to smoking crack. Our study suggests that respiratory symptoms and diagnoses of asthma and COPD are prevalent among a group of patients attending an inner-city clinic in Toronto and who also smoke crack. The high prevalence of smoking tobacco and marijuana among our participants is a major confounder for attributing respiratory symptoms to crack smoking alone. This novel pilot study can inform future research evaluating the primary health care management of respiratory disease among crack smokers, with the aim of improving health and health care delivery.
在加拿大的城市内人群中，通过吸入方式使用可卡因的现象十分普遍。吸食可卡因会导致急性呼吸道症状和并发症，但人们对与吸食可卡因相关的慢性呼吸道问题知之甚少。在涉及吸食可卡因者在初级保健中呼吸疾病管理的文献中也存在空白。我们研究的目的是评估在使用可卡因的人群中，吸食可卡因对其在初级保健中出现急性和慢性呼吸道症状的影响。我们在一家城市内初级保健中心的“即到即看诊所”中对 20 名目前吸食可卡因（过去 30 天内吸食过）的患者进行了试点研究。参与者完成了 20-30 分钟的访谈式调查，并同意对其病历进行审查。我们收集了与呼吸道相关的症状、诊断、检查、药物和专科就诊信息。数据使用 SPSS（版本 19.0）中的频率列表进行分析。在调查中，95%（19/20）的参与者报告在过去一周内至少有一个呼吸道症状。13 人（13/19，68.4%）报告这些症状令人困扰。病历审查显示，12/20（60%）人被诊断为哮喘或慢性阻塞性肺疾病（COPD），4 名参与者（4/20，20%）同时被诊断为哮喘和 COPD。大多数参与者都被开具了吸入性药物（调查 16/20，80%；病历 12/20，60%）。我们发现，20/20（100%）的参与者目前吸烟，16/20（80%）在吸食可卡因之前同时吸烟草和大麻。我们的研究表明，在多伦多一家城市诊所就诊的一组患者中，呼吸症状和哮喘及 COPD 的诊断较为普遍，且他们也吸食可卡因。我们参与者中吸烟草和大麻的高患病率是将呼吸道症状归因于吸食可卡因的主要混杂因素。这项新颖的试点研究可以为评估吸食可卡因者的初级保健中呼吸疾病管理提供信息，目的是改善健康和医疗服务的提供。
