Thread by @danlewer

(1/9) #COPD is extremely common among people who use heroin. We studied treatment and outcomes in this important patient group. Diagnosis is often late, and the risk of exacerbations is double that of other patients. New research in @BMJMedicine bmjmedicine.bmj.com/content/1/1/e0…

(2/9) We studied a large cohort of >100k people with a history of using heroin and other illicit opioids in England. In this cohort, the rate of death with a primary cause of COPD was 15x greater than for people of the same age in the general population.

(3/9) Approximately 4,000 people in this cohort were diagnosed with COPD by their GP. We matched each with 5 other patients of the same age and sex at the same GP surgery who were also diagnosed with COPD, but did not use illicit opioids.

(4/9) Patients with a history of using opioids were more likely to be underweight, severely breathless, and have low spirometry values. This may reflect later diagnosis due to normalisation of discomfort or 'diagnostic overshadowing'.

(5/9) Diagnostic overshadowing can happen when a clinician assumes that symptoms such as coughing or breathlessness are attributable to drug use, and therefore does less investigation.

(6/9) We also looked at treatment. We did not find inequality in medication, referrals for pulmonary rehab, support for smoking cessation, or flu and pneumococcal vaccines. A history of using heroin was not associated with lower probability of getting these treatments.

(7/9) However, after adjusting for the increased severity of COPD, we found that patients with a history of using opioids had double the risk of an exacerbation requiring hospital admission. This may reflect ongoing smoking or a difference in the effectiveness of COPD management.

(8/9) There are complex relationships between smoking, drug use, and healthcare access. Some facts are clear: the extremely high rate of COPD, late diagnosis, and high rate of exacerbations. Our data suggest people who use heroin do engage with their GP once diagnosed.

(9/9) We suggest two priorities - (1) support for smoking cessation in drug and alcohol services. Only 2% of clients who smoke are offered support; (2) development of respiratory clinics in drug and alcohol services to help clients get symptoms checked.

New research with @Sharon_ACox, @ProfHurst, @_prianka_, @i_petersen and Jennifer Quint, and funded by @NIHRresearch

Lots of excellent work funded by
@NIHRresearch: review of smoking cessation for people in treatment (evidence.nihr.ac.uk/alert/stop-smo…),
@Sharon_ACox's trial of e-cigarettes in homeless centres (onlinelibrary.wiley.com/doi/full/10.11…), and current call for evidence: nihr.ac.uk/funding/2279-s…