P118 Reaching the ‘unreachable’

Abstract

Introduction COPD is a heterogeneous and frequently debilitating respiratory, the majority of patients diagnosed with COPD have a history of nicotine smoking. There is less evidence regarding the prevalence of COPD amongst those with a history of crack/heroin smoking despite it being associated with early onset severe COPD. A screening pilot in Liverpool drug services in 2016 showed 47% of the patients had obstruction on spirometry, compatible with a diagnosis of COPD. Within Knowsley, a comprehensive respiratory assessment programme was set up within the local drug service as it is well known that this patient group engages poorly with non-emergency medical services. Method Between January 2018 and June 2018 diagnostic spirometry with reversibility was offered within two venues of the local drug service (CGL) in Knowsley, (CAT scores, smoking history and MRC were measured in addition), to those at risk of COPD. Patients with abnormal spirometry or abnormal CAT (>10) were offered a medical appointment to clarify diagnosis, optimise medication and arrange further tests as required. Results The service has seen 100 patients so far, these accounts for 20% of the service users who are likely to require assessment. 100 (100%) of the patients reviewed were current/ex nicotine smokers, 80 (80%) were current/ex heroin/crack smokers and 10 (10%) were current/ex cannabis smokers. 75 patient have had a confirmed diagnosis of COPD. Conclusion The proportion of patients with normal spirometry who were found to have underlying respiratory conditions was high within this cohort. Screening programmes utilising spirometry alone may miss a significant number of these patients with underlying respiratory conditions. Aligning respiratory services with the local drug service proved popular and feasible, allowing appropriate management to this historically ‘unreachable’ group.