Screening Heroin Smokers Attending Community Drug Clinics for Change in Lung Function: A Cohort Study

Chest. 2020 Mar;157(3):558-565. doi: 10.1016/j.chest.2019.11.006. Epub 2019 Nov 22.


Background: Heroin smokers have high rates of COPD, respiratory morbidity, hospital admission, and mortality. We assessed the natural history of symptoms and lung function in this population over time.

Methods: A cohort of heroin smokers with COPD was followed for 18 to 24 months. At baseline and follow-up, respiratory symptoms were measured by the Medical Research Council Dyspnea Scale (MRC) and the COPD Assessment Tool (CAT), and postbronchodilator spirometry was performed. Frequency of health-care-seeking episodes was extracted from routine health records. Parametric, nonparametric, and linear regression models were used to analyze the change in symptoms and lung function over time.

Results: Of 372 participants originally recruited, 161 were assessed at follow-up (mean age, 51.0 ± 5.3 years; 74 women [46%]) and 106 participants completed postbronchodilator spirometry. All participants were current or previous heroin smokers, and 122 (75.8%) had smoked crack. Symptoms increased over time (MRC score increased by 0.48 points per year, P < .001; CAT score increased by 1.60 points per year, P < .001). FEV1 declined annually by 90 ± 190 mL (P < .001). This deterioration was not associated with change in tobacco or heroin smoking status or use of inhaled medications.

Conclusions: Heroin smokers experience a high and increasing burden of chronic respiratory symptoms and a decline in FEV1 that exceeds the normal age-related decline observed among tobacco smokers with COPD and healthy nonsmokers. Targeted COPD diagnostic and treatment services hosted within opiate substitution services could benefit this vulnerable, relatively inaccessible, and underserved group of people.

Keywords: COPD; heroin; opiate; spirometry.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Bronchodilator Agents / therapeutic use
  • Cigarette Smoking / epidemiology
  • Cigarette Smoking / physiopathology
  • Cocaine Smoking / epidemiology
  • Cocaine Smoking / physiopathology
  • Cohort Studies
  • Disease Progression
  • Emergency Service, Hospital / statistics & numerical data
  • Female
  • Forced Expiratory Volume
  • Heroin Dependence / drug therapy
  • Heroin Dependence / epidemiology
  • Heroin Dependence / physiopathology*
  • Hospitalization / statistics & numerical data
  • Humans
  • Longitudinal Studies
  • Lung / physiopathology*
  • Male
  • Marijuana Smoking / epidemiology
  • Marijuana Smoking / physiopathology
  • Mass Screening
  • Middle Aged
  • Opiate Substitution Treatment
  • Primary Health Care / statistics & numerical data
  • Pulmonary Disease, Chronic Obstructive / epidemiology
  • Pulmonary Disease, Chronic Obstructive / physiopathology*
  • Severity of Illness Index
  • Smoking, Non-Tobacco Products / epidemiology
  • Smoking, Non-Tobacco Products / physiopathology*
  • Spirometry


  • Bronchodilator Agents