In the 1990s inhalation ('chasing the dragon') became the predominant method of recreational opiate (heroin and crack cocaine) consumption as it was perceived to have fewer detrimental health effects than injection. Although clinicians encounter individuals with COPD associated with opiate smoking ('heroin lung') the airway effects and symptoms resulting from opiate smoking are not established. We recruited 145 current and past opiate users from a local community drug service and recorded demographics. They completed spirometry pre and post salbutamol and questionnaires addressing drug use, symptoms and health status. Lower limit of normal was used to define airflow obstruction. Ten subjects failed to produce adequate spirometry, 26 had only injected and never smoked opiates while 6 subjects had marked bronchodilator (BD) reversibility consistent with asthma. Thirty six subjects appeared to have COPD and these were compared with 67 opiate smokers with normal post-BD spirometry and the 26 subjects who only injected opiates. The results from the 3 groups are shown in the table. The COPD group was a little older and necessarily had a lower FEV1 and post-BD airflow obstruction. There was little difference in length of drug use when the opiate smokers with COPD were compared to those without and the frequency of cough and phlegm differed little. Opiate smokers with COPD had modestly higher rates of wheeze and breathlessness; hence, higher CAT and MRC dyspnoea scores, but respiratory symptoms and use of respiratory medication were common in the non-COPD groups. Heroin and crack cocaine smoking is a risk factor for the development of irreversible airflow obstruction at a very young age. Respiratory symptoms are common in opiate smokers irrespective of the presence of COPD and not uncommon in those who have only injected opiates. In many, this is associated with a reduced health status despite normal spirometry; hence, symptoms are not a useful way to 'diagnose' COPD and spirometry is essential. P124 CHRONIC BRONCHITIS AMONG FISHERMEN IN EXPOSED TO FIREWOOD SMOKEVA Umoh; University of Uyo Teaching Hospital, Uyo, Nigeria 10. 1136/thoraxjnl-2013-204457.274 Background Biomass is heavily depended on for domestic energy use by people in developing countries. These materials are typically burnt in simple stoves and produce a lot of smoke. Exposure to this indoor air pollution has been linked to a number of respiratory disorders. This study aimed to assess some long term effects exposure to indoor air pollution among fishermen. Methods A survey was conducted in a fishing community in Nigeria among 337 fishermen exposed to indoor air pollution from burning firewood and 345 matched controls. Exposure was determined by the product of the average daily duration of time spent close to the fire and the number of years (Hour-years). A modified BMRC questionnaire was used to obtain information on respiratory symptoms and spirometry was performed on the participants. Results The frequency of chronic respiratory symptoms was signific...
COPD is associated with social deprivation which can reinforce health inequality, especially in difficult to access groups. Heroin and crack smoking is associated with early onset severe COPD but this population engages poorly with non-emergency medical services although they engage effectively with specialist drug services. As such, despite an expansion in community spirometry provision, different models of care may be needed to optimise COPD diagnosis and management. In order to access this group Liverpool Clinical Commissioning Group (CCG) funded a COPD screening programme where all current and former heroin and crack smokers using local drug services were offered spirometry at drug key worker appointments where they collected their opiate substitute prescription. If willing they also completed MRC, CAT, a record of cigarette and drug exposure and had oxygen saturations measured. They also provided feedback about the programmeEight hundred and seven (807) out of the population of 1100 participated which represents 73% of the client group. Airflow obstruction consistent with COPD was present in 379 (47%) with a further 50 (6%) having reversible airflow obstruction consistent with asthma. Of those with COPD, 154 (41%) had mild, 144 (38%) moderate and 81 (21%) severe or very severe COPD. Mean FEV1 was 2.93L (0.93), mean CAT was 19.5 (10.5) and mean MRC was 2.64 (1.29). Of the 379 with COPD, only a minority (41%) were diagnosed, a third of people were prescribed no inhaler therapy and, when prescribed, treatment was typically sub-optimal. Amongst those with COPD, 337 (90%) were current cigarette smokers while 93 (25%) and 105 (28%) still smoked crack and heroin respectively.When asked to feedback 96% of respondents were happy with the process and 93% would be willing to attend future COPD appointments at drug centres.Anchoring spirometry to key worker appointments in heroin and crack smokers was popular amongst service users and a majority completed spirometry. Airway disease was present in a majority with 47% having mostly undiagnosed but symptomatic COPD with significant scope to improve treatment. This model of screening and treatment improved healthcare access and could be used in other hard to reach groups, such as the homeless.
IntroductionThe clinical presentation of Covid-19 varies widely with only a small proportion of those infected requiring hospitalisation. The ability to risk stratify patients upon presentation to the Emergency Department (ED) facilitates early safe discharge, with or without enhanced monitoring, which benefits hospital capacity management and infection control. In other lung parenchymal conditions oxygen desaturation during exercise has been used as an indicator of more severe disease. The exercise modality has typically been a field walking test or a bicycle or treadmill test which are impractical for delivery in ED. We investigated whether an alternative test, the 1-minute sit to stand test (1SST), was deliverable within an ED at the height of the COVID-19 pandemic. Methods During April to June 2020 at two large hospitals we performed 1SST in 201 people presenting with suspected Covid-19 and measured test performance (reps) plus change in pulse and oxygen saturations. Subsequently we identified clinical outcomes for all individuals diagnosed with Covid-19. A positive test was defined as 4% desaturation. ResultsThe test was deliverable with 193/201 (96%) able to complete (2 were too unsteady, 6 failed to complete the minimum 5 reps). 111 (55%) were female, mean age of 49 (SD 16) years and an average of 17 (SD 7) reps completed. Mean fall in saturations was -1.6% and rise in pulse was 22. 34 people were diagnosed with Covid-19 based on a) positive swab or b) negative swab but diagnosed with 'clinical Covid-19' by a senior clinician based on clinical and radiological features. 1 person was unable to complete the 1SST test. The outcomes for people with a positive or negative test are shown in the table 1. In the early part of the study we were only able to swab people admitted to hospital so data from 109 further people is not included in the primary analysis. Conclusion The 1SST is feasible for people presenting acutely with Covid-19. It effectively identifies exercise induced oxygen desaturation and therefore augments the decision making relating to hospital admission.
In the 1990s inhalation ('chasing the dragon') became the predominant method of recreational opiate (heroin and crack cocaine) consumption as it was perceived to have fewer detrimental health effects than injection. Although clinicians encounter individuals with COPD associated with opiate smoking ('heroin lung') the airway effects and symptoms resulting from opiate smoking are not established. We recruited 145 current and past opiate users from a local community drug service and recorded demographics. They completed spirometry pre and post salbutamol and questionnaires addressing drug use, symptoms and health status. Lower limit of normal was used to define airflow obstruction. Ten subjects failed to produce adequate spirometry, 26 had only injected and never smoked opiates while 6 subjects had marked bronchodilator (BD) reversibility consistent with asthma. Thirty six subjects appeared to have COPD and these were compared with 67 opiate smokers with normal post-BD spirometry and the 26 subjects who only injected opiates. The results from the 3 groups are shown in the table. The COPD group was a little older and necessarily had a lower FEV1 and post-BD airflow obstruction. There was little difference in length of drug use when the opiate smokers with COPD were compared to those without and the frequency of cough and phlegm differed little. Opiate smokers with COPD had modestly higher rates of wheeze and breathlessness; hence, higher CAT and MRC dyspnoea scores, but respiratory symptoms and use of respiratory medication were common in the non-COPD groups. Heroin and crack cocaine smoking is a risk factor for the development of irreversible airflow obstruction at a very young age. Respiratory symptoms are common in opiate smokers irrespective of the presence of COPD and not uncommon in those who have only injected opiates. In many, this is associated with a reduced health status despite normal spirometry; hence, symptoms are not a useful way to 'diagnose' COPD and spirometry is essential. P124 CHRONIC BRONCHITIS AMONG FISHERMEN IN EXPOSED TO FIREWOOD SMOKEVA Umoh; University of Uyo Teaching Hospital, Uyo, Nigeria 10. 1136/thoraxjnl-2013-204457.274 Background Biomass is heavily depended on for domestic energy use by people in developing countries. These materials are typically burnt in simple stoves and produce a lot of smoke. Exposure to this indoor air pollution has been linked to a number of respiratory disorders. This study aimed to assess some long term effects exposure to indoor air pollution among fishermen. Methods A survey was conducted in a fishing community in Nigeria among 337 fishermen exposed to indoor air pollution from burning firewood and 345 matched controls. Exposure was determined by the product of the average daily duration of time spent close to the fire and the number of years (Hour-years). A modified BMRC questionnaire was used to obtain information on respiratory symptoms and spirometry was performed on the participants. Results The frequency of chronic respiratory symptoms was signific...
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