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Smoking heroin linked to early-onset COPD with emphysema phenotype

The inhalation of heroin for recreational purposes appears to be associated with early-onset COPD, and specifically with an emphysema phenotype, according to the results of a recent study.

Paul P. Walker, MD, of the Clinical Science Centre at University Hospital Aintree in Liverpool, United Kingdom and colleagues retrospectively acquired data on 44 individuals identified from the clinical respiratory service at University Hospital Aintree between 2005 and 2013. Eligible participants met the following criteria: minimum of 5 years’ history of regular heroin smoking, clinical diagnosis of COPD, presence of chronic respiratory symptoms (breathlessness, wheeze, and productive or nonproductive cough) that began at age 40 or younger, and having undergone spirometry at least once during a time of clinical stability.

Participants also underwent lung function testing, high-resolution CT scans, and static lung volume testing. The researchers recorded the number of years each participant had smoked heroin. The mean age of the group at diagnosis was 41 years, and study participants had smoked heroin for a mean of 14 years.

The researchers found that among the cohort, the mean forced expiratory volume (FEV₁) was 1.08L (31.5% predicted), and the mean FEV₁/FVC was 0.4. None of the participants were found to have severe-alpha-2 antitrypsin insufficiency. Forty-four of the participants had either a CT scan or lung diffusion measurement. In general, the overall high-resolution CT emphysema scores calculated across the upper, lower and middle part of the lung was 2.3 (5% to 25% emphysema), with 47% of participants presenting with an upper lobe emphysema score of 3 or higher (20% to 25% emphysema). Median reduced lung diffusion was 48% of the value predicted, and accorded with an emphysema phenotype.

According to the researchers, all of the prior heroin smokers developed respiratory symptoms prior to age 40, and a number had died by this age.

“We have shown that smoking heroin is associated with early onset COPD, in particular with an emphysema phenotype,” the researchers wrote. “All deaths were attributable to respiratory failure/COPD. It is important that smoking opiates is considered as a risk factor for early onset COPD, and with an estimated 250,000 current or former opiate users in England and many more worldwide this is an important public health message with implications for screening and case finding.”

Disclosure: The researchers report no relevant disclosures.