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Screening in community drug services: where there is smoke, there is COPD
Heroin smoking, rather than injection, has become more prevalent over the last 30 years. Drug smokers have a significant burden of respiratory morbidity with higher hospital admission rates compared with the general chronic obstructive pulmonary disease (COPD) population; this may in part be due to limited engagement with conventional health services. Burhan and colleagues (Chest 2018; doi: 10.1016/j.chest.2018.08.1049) performed a cross-sectional study in Liverpool to investigate the prevalence and severity of COPD in this population, and the acceptability of attaching COPD screening services to community specialist drug services. Of the 1082 patients approached to participate, 753 completed the full assessment, 70% had some form of airways disease, with 260 (35%), 155 (21%) and 112 (15%) found to have COPD, asthma and asthma–COPD overlap, respectively. Interestingly, around half of participants who had reported a previous COPD diagnosis did not have evidence of irreversible obstructive spirometry, reiterating the importance of objective assessment of respiratory disease, even in a high-risk population. Longer duration, rather than quantity per se, of tobacco and illicit drug inhalation were associated with increased risk of …
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