Abstract
Purpose
Patients with obstructive pulmonary disease (asthma or chronic obstructive pulmonary disease—COPD) who smoke illicit drugs are at an increased risk of hospital admissions. We compared hospital readmission rates due to exacerbations of obstructive pulmonary disease amongst patients who were current/ex-illicit drug smokers versus current/ex-tobacco smokers.
Methods
We reviewed all the admissions between January 2009 and September 2011 with a presumptive diagnosis of an ‘exacerbation of COPD’ retrospectively from our COPD admission database.
Results
There were 950 sequential hospital admissions in 709 patients over a 33-month period; 250 ex-tobacco smokers, 370 current tobacco smokers and 89 current/ex-illicit drug smokers. Recurrent hospital admission rates with exacerbation of obstructive pulmonary disease were higher in the illicit drug smokers compared with current/ex-tobacco smokers (1.00 versus 0.22/0.26, p < 0.001). Illicit drug smokers were younger [50 versus 72.9/69.9 (mean 71.2) years, p < 0.001] and had shorter length of hospital stay [7.44 versus 9.28/10.69 (mean 9.87) days, p = 0.038]. Illicit drug smokers with FEV1 < 1 litre (L) had higher readmissions than ex/current tobacco smokers with FEV1 < 1 L (p < 0.001). Admissions requiring non-invasive ventilation for type 2 respiratory failure were more common in illicit drug smokers (8.4 versus 3 %, p < 0.002).
Conclusion
We have shown that readmission rates in illicit drug smokers with FEV1 < 1 L are higher than in tobacco smokers. Studies are needed to determine whether targeting these illicit drug users with an intensive community intervention package (to include early therapy, pulmonary rehabilitation) will reduce readmission rates in this often neglected population.
Similar content being viewed by others
References
Tan WC, Lo C, Jong A, Xing L, Fitzgerald MJ, Vollmer WM et al (2009) Marijuana and chronic obstructive lung disease: a population-based study. CMAJ 180(8):814–820
Benson M, Bentley AM (1995) Lung disease induced by drug addiction. Thorax 50:1125–1127
Bloom JW, Kaltenborn WT, Paoletti P, Camilli A, Lebowitz MS (1987) Respiratory effects of non-tobacco cigarettes. BMJ 295:1516–1518
Palmer F, Jaffray M, Moffat MA, Matheson C, McLernon D, Coutts A et al (2012) Prevalence of common chronic respiratory diseases in drug misusers: a cohort study. Prim Care Respir J 21(4):377–383
Tashkin DP, Simmons MS, Tseng CH (2012) Impact of changes in regular use of marijuana and/or tobacco on chronic bronchitis. COPD 9(4):367–374
Hughes S, Calverley PM (1988) Heroin inhalation and asthma. BMJ 297(6662):1511–1512
Polen MR, Sidney S, Tekawa I, Sadler M, Friedman G (1993) Healthcare use by frequent marijuana smokers who do not smoke tobacco. West J Med 158:596–601
Lewis-Burke N, Wooding O, McKinnell K, Davies L, Walker PP (2013) Opiate smokers have a high prevalence of respiratory symptoms irrespective of airflow obstruction. Thorax 68(Suppl 3):A131. doi:10.1136/thoraxjnl-2013-204457.273
de los Pérez Cobos J, Trujols J, Ribalta E et al (1997) Cocaine use immediately prior to entry in an inpatient heroin detoxification unit as a predictor of discharges against medical advice. Am J Drug Alcohol Abuse 23:267–279
Schwartz RH (1987) Marijuana: an overview. Pediatr Clin North Am 34:305–317
Wu TC, Tashkin DP, Djahed B, Rose JE (1988) Pulmonary hazards of smoking marijuana as compared with tobacco. N Engl J Med 318:347–351
Roth MD, Arora A, Barsky SH, Kleerup EC, Simmons M, Tashkin DP (1998) Airway inflammation in young marijuana and tobacco smokers. Am J Respir Crit Care Med 157:928–937
Tridimas A, Archer T, Rehman Z, Oelbaum S, Burhan H (2013) Thorax 68(Suppl 3):A132. doi:10.1136/thoraxjnl-2013-204457.276
Van der Klooster JM, Grootendorst AF (2001) Severe bullous emphysema associated with cocaine smoking. Thorax 56:982–983
Johnson MK, Smith RP, Morrison D, Laszlo G, White RJ (2000) Large lung bullae in marijuana smokers. Thorax 55:340–342
Tashkin DP, Fligiel S, Wu TC, Gong H Jr, Barbers RG, Coulson AH et al (1990) Effects of habitual use of marijuana and/or cocaine on the lung. NIDA Res Monogr 99:63–87
Tashkin DP, Simmons MS, Coulson AH, Clark VA, Jr Gong H (1987) Respiratory effects of cocaine ‘‘freebasing’’ among habitual users of marijuana with or without tobacco. Chest 92(4):638–644
Buster M, Rook L, van Brussel GH, van Ree J, van den Brink W (2002) Chasing the dragon, related to the impaired lung function among heroin users. Drug Alcohol Depend 68(2):221–228
Taylor DR, Fergusson DM, Milne BJ, Horwood LJ, Moffitt TE, Sears MR et al (2002) A longitudinal study of the effects of tobacco and cannabis exposure on lung function in young adults. Addiction 97(8):1055–1061
Samet JH, Friedmann P, Saitz R (2001) Benefits of linking primary medical care and substance abuse services: patient, provider, and societal perspectives. Arch Intern Med 161(1):85–91
Samet JH, Larson MJ, Horton NJ, Doyle K, Winter M, Saitz R (2003) Linking alcohol- and drug-dependent adults to primary medical care: a randomized controlled trial of a multi-disciplinary health intervention in a detoxification unit. Addiction 98(4):509–516
Acknowledgments
We thank SN Tracey Perry, COPD Specialist Nurse at Royal Liverpool University Hospital for data acquisition.
Conflict of interest
The authors declare that they have no conflicts of interest in relation to this article.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Yadavilli, R., Collins, A., Ding, W.Y. et al. Hospital Readmissions with Exacerbation of Obstructive Pulmonary Disease in Illicit Drug Smokers. Lung 192, 669–673 (2014). https://doi.org/10.1007/s00408-014-9632-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00408-014-9632-3