Lewis-Burke Nadia, Vlies Ben, Wooding Olivia, Davies Lisa, Walker Paul P
a Respiratory Research Department, Clinical Sciences Centre, Aintree University Hospital , Liverpool , United Kingdom .
b Crime Reduction Initiative Sefton, Sefton House , Sefton , Merseyside , United Kingdom .
COPD. 2016 Jun;13(3):333-8. doi: 10.3109/15412555.2015.1082999. Epub 2015 Dec 23.
Over the last 20 years smoking has become the most common method of heroin use and increasing numbers of heroin smokers are presenting to local medical services, before the age of 40 years, with severe airway disease. To determine COPD prevalence we recruited 129 subjects from two local community drug services, of whom 107 were heroin smokers. We collected demographic, medical and treatment data, smoking history (including cannabis and opiates) and details of symptoms including MRC dyspnoea. Subjects completed the COPD Assessment Tool and spirometry. Thirty heroin smokers were identified as having COPD resulting in a COPD prevalence of 28%. Mean age was 43 (4) years and FEV1 was 2.71 (0.98) L; 70 (23) %predicted. Breathlessness and wheeze were more common in subjects with COPD (p < 0.04 and p < 0.05) but symptoms were common in all heroin smokers. MRC score was higher (3 vs. 2.4; p < 0.04) in those with COPD and health status appeared poorer (CAT 20.4 vs. 15.8; p < 0.07). Only 4 (11%) had previously been diagnosed with COPD and only 16 (53%) received any inhaled medication. Asthma prevalence was also high at 33% and asthmatic subjects had similar symptoms and health status compared with the COPD subjects, and were also significantly undertreated. COPD and asthma are common in current and former heroin smokers. They are often present at a young age and are underdiagnosed and undertreated. Awareness of this issue should be highlighted within drug services and in particular to heroin smokers. Screening this high-risk population with spirometry should be considered.
在过去20年里，吸烟已成为使用海洛因最常见的方式，越来越多的海洛因吸烟者在40岁之前因严重气道疾病前往当地医疗服务机构就诊。为了确定慢性阻塞性肺疾病（COPD）的患病率，我们从两个当地社区戒毒服务机构招募了129名受试者，其中107名是海洛因吸烟者。我们收集了人口统计学、医学和治疗数据、吸烟史（包括大麻和阿片类药物）以及症状细节，包括医学研究委员会（MRC）呼吸困难量表。受试者完成了COPD评估工具和肺功能测定。30名海洛因吸烟者被确诊患有COPD，COPD患病率为28%。平均年龄为43（4）岁，第一秒用力呼气容积（FEV1）为2.71（0.98）升，占预计值的70（23）%。呼吸困难和喘息在COPD患者中更为常见（p < 0.04和p < 0.05），但所有海洛因吸烟者都有这些症状。COPD患者的MRC评分更高（3分对2.4分；p < 0.04），健康状况似乎更差（COPD评估测试[CAT]评分为20.4分对15.8分；p < 0.07）。只有4（11%）人之前被诊断患有COPD，只有16（53%）人接受过任何吸入药物治疗。哮喘患病率也高达33%，哮喘患者与COPD患者有相似的症状和健康状况，且治疗也明显不足。COPD和哮喘在当前及既往海洛因吸烟者中很常见。它们通常在年轻时出现，诊断不足且治疗不足。应在戒毒服务机构中，尤其是向海洛因吸烟者强调这一问题。应考虑对这一高危人群进行肺功能测定筛查。
