Introduction and objectives 42% of UK tobacco smoked is consumed by people with mental disorders.1 Smoking prevalence, and the proportion of highly-dependent smokers, are increased in patients with severe mental illness (SMI) and smoking is the main cause of high premature mortality in this group.1 The prevalence of COPD, a disease with >85% smoking-attributable deaths, in psychiatric in-patients is unknown and patients with SMI are less likely to have physical-health-checks and treatment.1 We hypothesised that COPD is under-diagnosed and under-treated in in-patients with SMI.
Methods Case notes review and a structured smoking/respiratory assessment, using NICE COPD guidance with spirometry/oximetry,2 were performed for in-patients with SMI over 1 month on three long-term psychiatric wards in an inner-city mental health trust.
Results Patient demographics are shown in the Table.
34/41 (83%) were confirmed current tobacco smokers with mean (SD) 34 (28) pack-years; 5 were non-smokers and 2 ex-smokers. 24/41 (59%) were previous/current cannabis smokers.
Quit Smoking Support (QSS) was offered to 25/34 (74%) tobacco smokers with medication prescribed for 9/34 (26%). Median (range) self-assessed MRC-breathlessness score was 1 (1–2); (n = 16 and 18 did not engage). Mean (SD) oxygen saturation was 96.6 (2.4)% (n = 21; 13 did not engage). Three smokers (9%) had an existing diagnosis of COPD. 18/28 eligible patients had spirometry; 10 (36%) did not engage. Mean (SD) FEV1 was 2.41 (1.01) L; 4 /18 (22%) were obstructive. 3/6 (50%) smokers with COPD (1 ex-smoker) were offered QSS and 2 were referred for respiratory input.
Conclusions COPD prevalence was 17% in this in-patient group, over half of whom were undiagnosed. A third of patients declined spirometry, reflecting challenges of engagement in SMI. Nevertheless 2 in 9 tests resulted in new COPD diagnoses. Smoking prevalence was high at 83% but 1 in 5 smokers were not offered QSS, including half of those with COPD. These results support the case for respiratory-mental health collaborations during long psychiatric admissions.
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.