Results from a recent study published in the Journal CHEST show that there is an association between heroin inhalation and early-onset COPD, particularly with an emphysema phenotype.

For this study, the research team from the Clinical Science Centre at University Hospital Aintree in Liverpool, UK, led by Paul P. Walker, MD, retrospectively sought data from the clinical respiratory service at University Hospital Aintree from 2005 to 2013. The results were obtained from a cohort of 73 heroin smokers with a diagnosis of COPD, where symptoms developed before the age of 40 years.

Eligible participants for the study had clinical diagnosis of COPD, presence of chronic respiratory symptoms such as wheezing, breathlessness, and productive or nonproductive cough, and at least 5 years’ history of regular heroin smoking.

All participants undertook lung function and static lung volume assessment, and high-resolution CT scans. The investigators documented the number of years each study participant had smoked heroin. Results showed that participants had smoked heroin for an average of 14 years and had a mean age of 41 years. Mean FEV₁ was 1.08L (31.5% predicted) with mean FEV₁/FVC of 0.4.

There were no participants in the study suffering from severe alpha-1-anti-trypsin deficiency. A total of 44 participants had a lung diffusion (12) or high-resolution CT scan (32) assessment.

Results also showed that the overall HRCT emphysema result across the lower, middle and upper part of the lung was 2.3 (5-25% emphysema). A total of 47% of the study participants had an upper lobe emphysema result of 3 or greater (25-50% emphysema).

Researchers indicated that all of the prior smokers of heroin developed respiratory problems before the age of 40 years, and several 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.”