Exploring perspectives on chronic obstructive pulmonary disease in people who smoke heroin: a qualitative study.

BACKGROUND: Smoking rather than injecting heroin has become more common over the last 20 years. Although there is an increasing body of evidence describing high levels of chronic obstructive pulmonary disease (COPD) in people who smoke heroin, there is limited evidence documenting the impact of the long-term condition on this population group. AIM: This study aimed to describe the experiences of people who smoke heroin with COPD in Liverpool, UK. DESIGN & SETTING: Participants were purposefully sampled for this qualitative study. They included adults enrolled in an opioid replacement clinic run by Addaction in Liverpool, who had already engaged with spirometry testing for COPD as part of a previous study. METHOD: Semi-structured interviews were performed with participants with spirometrically confirmed COPD in opioid replacement clinics. Data were analysed using a framework analysis approach. RESULTS: Sixteen potential participants were invited to take part in the study, of which 10 agreed and were interviewed. Three themes common to all interviews were identified: functional measures of lung health that impacted on their activities of daily living; inhaler and medication perceptions with erratic use that was not concordant with their prescription; and the impact of difficulties accessing care. CONCLUSION: These findings, along with previous studies highlighting the prevalence of COPD in this population, warrant efforts to integrate community COPD and opioid replacement services to improve outcomes for this vulnerable population.

Screening Heroin Smokers Attending Community Drug Clinics for Change in Lung Function: A Cohort Study.

BACKGROUND: Heroin smokers have high rates of COPD, respiratory morbidity, hospital admission, and mortality. We assessed the natural history of symptoms and lung function in this population over time. METHODS: A cohort of heroin smokers with COPD was followed for 18 to 24 months. At baseline and follow-up, respiratory symptoms were measured by the Medical Research Council Dyspnea Scale (MRC) and the COPD Assessment Tool (CAT), and postbronchodilator spirometry was performed. Frequency of health-care-seeking episodes was extracted from routine health records. Parametric, nonparametric, and linear regression models were used to analyze the change in symptoms and lung function over time. RESULTS: Of 372 participants originally recruited, 161 were assessed at follow-up (mean age, 51.0 ± 5.3 years; 74 women [46%]) and 106 participants completed postbronchodilator spirometry. All participants were current or previous heroin smokers, and 122 (75.8%) had smoked crack. Symptoms increased over time (MRC score increased by 0.48 points per year, P < .001; CAT score increased by 1.60 points per year, P < .001). FEV1 declined annually by 90 ± 190 mL (P < .001). This deterioration was not associated with change in tobacco or heroin smoking status or use of inhaled medications. CONCLUSIONS: Heroin smokers experience a high and increasing burden of chronic respiratory symptoms and a decline in FEV1 that exceeds the normal age-related decline observed among tobacco smokers with COPD and healthy nonsmokers. Targeted COPD diagnostic and treatment services hosted within opiate substitution services could benefit this vulnerable, relatively inaccessible, and underserved group of people.

Seasonal influenza immunization program outside general practice: An evaluation.

With the support of our local Public Health and NHS England teams, we developed a pathway of care to provide seasonal influenza vaccination to our heroin dependent service users. 340 of the 515 service users receiving opioid substitution treatment (OST) were offered the vaccination in the 2014/15 influenza season and 205 accepted it. A further 29 service users received the vaccination elsewhere. With over 50% of those on OST prescriptions known to have a diagnosed chronic condition, such as liver or respiratory disease, this was a worthwhile health intervention in a population that is known to be "hard to reach." In addition to the potential benefit to the individuals who received the seasonal influenza vaccination, there was also an opportunity to provide health advice and information surrounding chronic disease management. Service user feedback overwhelmingly supported the provision of seasonal influenza vaccination within Drug and Alcohol services.

Reporting of adverse drug reactions by nurses.

Schemes for spontaneous reporting of adverse drug reactions are important to post-marketing safety surveillance worldwide. In the UK, doctors, dentists, coroners, and pharmacists are allowed to report through the yellow card scheme, but nurses were not until October, 2002. We used a similar programme to assess the role of community and hospital nurses in reporting of adverse drug reactions. The proportion and quality of reports received from nurses was similar to that of those received from doctors: we received reports from one in seven nurses eligible to report, compared with one in eight doctors; 137 of 177 nurse reports and 676 of 984 doctor reports were judged to be appropriate according to regulatory authority criteria (95% CI for difference between proportions 1.4-15.0, z=2.3, p=0.02). Our findings suggest that nurses, who form the largest proportion of health-care staff in the UK, can play a valuable part in improvement of pharmacovigilance.

Pre-registration nurse education in pharmacology: is it adequate for the roles that nurses are expected to fulfil?

Nurse education has undergone many changes over the last 30 years in line with the changing expectations of the nurse's role. A review of the literature suggests that nurses are inadequately prepared for their role in medication administration. With the introduction of nurse prescribing, the issue of education in pharmacology is becoming increasingly important. This paper describes a study conducted via a questionnaire survey of all nurse education institutions in England. The aim of the survey was to identify current pharmacology education provided for pre-registration nurses, in terms of curriculum design and content, and also to elicit the personal opinions of those involved in the delivery of nurse education. The results support the notion that many nurses may be inadequately prepared for the role that they are expected to perform once qualified. The reasons for this appear to be complex, though they may include insufficient guidelines from the nursing regulatory bodies, local political difficulties and a lack of consistency between educational establishments.