TY - JOUR
KW - Adult
KW - Analgesics, Opioid/therapeutic use
KW - Asthma/epidemiology
KW - Case-Control Studies
KW - Cigarette Smoking/epidemiology
KW - Cross-Sectional Studies
KW - Female
KW - Humans
KW - Logistic Models
KW - Male
KW - Methadone/therapeutic use
KW - Middle Aged
KW - Opiate Substitution Treatment
KW - Opioid-Related Disorders/drug therapy/epidemiology
KW - Prevalence
KW - Primary Health Care
KW - Pulmonary Disease, Chronic Obstructive/epidemiology
KW - Risk
KW - United Kingdom/epidemiology
AU - S. Mehta
AU - N. Parmar
AU - M. Kelleher
AU - C. J. Jolley
AU - P. White
AU - S. Durbaba
AU - M. Ashworth
A1 - 
AB - Patients treated for drug addiction have high asthma and COPD prevalence rates. The relative contributions of cigarette smoking, smoking intensity and possible smoking of other substances has not been described. We aimed to describe the prevalence and determinants of asthma and COPD in patients prescribed methadone as opioid substitution therapy (OST). In a cross-sectional study of an anonymised patient-level primary care dataset of UK inner-city general practices (n = 46), 321,395 patients aged ≥18 years were identified. A total of 676 (0.21%) had a record of a methadone ever issued in primary care. The association between respiratory disease and methadone prescribing was examined using logistic regression. Models were adjusted for potential effects of clustering by practice. A total of 97.3% of patients prescribed methadone were cigarette smokers, either current (81.2%) or ex-smokers (16.1%). The prevalences of asthma and COPD were higher in methadone patients (14.2% and 12.4%, respectively) compared to non-methadone patients (4.4% and 1.1%, respectively). Methadone was an independent determinant of asthma, adjusting for smoking status (OR 3.21; 95% CI: 2.52, 4.10) or for smoking intensity (3.08; 2.27, 4.19), and of COPD, adjusting for smoking status (6.00; 4.61, 7.80) or for smoking intensity (5.80; 4.12, 8.17). COPD and asthma prevalence were substantially higher in those prescribed methadone compared to those never prescribed methadone. Prescription of methadone was an independent predictor for both COPD and asthma, even after adjustment for smoking status and smoking intensity. Possible explanations include confounding by association with smoking of heroin or crack cocaine, both of which may have a causal association with COPD and asthma.
AD - School of Population Health and Environmental Sciences, King's College London, Guy's Campus, Addison House, London, SE1 1UL, UK. shaine.mehta@kcl.ac.uk.; School of Population Health and Environmental Sciences, King's College London, Guy's Campus, Addison House, London, SE1 1UL, UK.; South London & Maudsley NHS Foundation Trust, Lorraine Hewitt House, 12-14 Brighton Terrace, Brixton, SW9 8DG, UK.; Centre for Human & Applied Physiological Sciences, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, Shepherd's House, Rm 4.4, Guy's Campus, London, SE1 1UL, UK.; School of Population Health and Environmental Sciences, King's College London, Guy's Campus, Addison House, London, SE1 1UL, UK.; School of Population Health and Environmental Sciences, King's College London, Guy's Campus, Addison House, London, SE1 1UL, UK.; School of Population Health and Environmental Sciences, King's College London, Guy's Campus, Addison House, London, SE1 1UL, UK.
BT - NPJ primary care respiratory medicine
C5 - Healthcare Disparities; Opioids & Substance Use
CP - 1
DO - 10.1038/s41533-019-0161-7
IS - 1
JF - NPJ primary care respiratory medicine
LA - eng
M1 - Journal Article
N2 - Patients treated for drug addiction have high asthma and COPD prevalence rates. The relative contributions of cigarette smoking, smoking intensity and possible smoking of other substances has not been described. We aimed to describe the prevalence and determinants of asthma and COPD in patients prescribed methadone as opioid substitution therapy (OST). In a cross-sectional study of an anonymised patient-level primary care dataset of UK inner-city general practices (n = 46), 321,395 patients aged ≥18 years were identified. A total of 676 (0.21%) had a record of a methadone ever issued in primary care. The association between respiratory disease and methadone prescribing was examined using logistic regression. Models were adjusted for potential effects of clustering by practice. A total of 97.3% of patients prescribed methadone were cigarette smokers, either current (81.2%) or ex-smokers (16.1%). The prevalences of asthma and COPD were higher in methadone patients (14.2% and 12.4%, respectively) compared to non-methadone patients (4.4% and 1.1%, respectively). Methadone was an independent determinant of asthma, adjusting for smoking status (OR 3.21; 95% CI: 2.52, 4.10) or for smoking intensity (3.08; 2.27, 4.19), and of COPD, adjusting for smoking status (6.00; 4.61, 7.80) or for smoking intensity (5.80; 4.12, 8.17). COPD and asthma prevalence were substantially higher in those prescribed methadone compared to those never prescribed methadone. Prescription of methadone was an independent predictor for both COPD and asthma, even after adjustment for smoking status and smoking intensity. Possible explanations include confounding by association with smoking of heroin or crack cocaine, both of which may have a causal association with COPD and asthma.
PY - 2020
SN - 2055-1010; 2055-1010
SP - 019
EP - 7
EP - 4+
T1 - COPD and asthma in patients with opioid dependency: a cross-sectional study in primary care
T2 - NPJ primary care respiratory medicine
TI - COPD and asthma in patients with opioid dependency: a cross-sectional study in primary care
U1 - Healthcare Disparities; Opioids & Substance Use
U2 - 31937808
U3 - 10.1038/s41533-019-0161-7
VL - 30
VO - 2055-1010; 2055-1010
Y1 - 2020
Y2 - Jan 14
ER -