title: Hospital readmissions with exacerbation of obstructive pulmonary disease in illicit drug smokers.
abstract: OBJECTIVE
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Respiratory Medicine, Royal Liverpool University Hospital, Prescot, Liverpool, L7 8XP, UK, dryadavilli@hotmail.com.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Yadavilli
authors.forename: Andrea
authors.initials: A
authors.lastname: Collins
authors.forename: Wern Yew
authors.initials: WY
authors.lastname: Ding
authors.forename: Nicola
authors.initials: N
authors.lastname: Garner
authors.forename: Janet
authors.initials: J
authors.lastname: Williams
authors.forename: Hassan
authors.initials: H
authors.lastname: Burhan
mesh_terms: D000368:Aged; D019970:Cocaine-Related Disorders / Q000150:complications / Q000503:physiopathology; D016208:Databases, Factual; D018450:Disease Progression; D004739:England; D005260:Female; D005541:Forced Expiratory Volume; D006556:Heroin Dependence / Q000150:complications / Q000503:physiopathology; D006801:Humans; D007902:Length of Stay; D008168:Lung / Q000503:physiopathology*; D008297:Male; D002189:Marijuana Abuse / Q000150:complications / Q000503:physiopathology; D008385:Marijuana Smoking / Q000009:adverse effects / Q000503:physiopathology; D008875:Middle Aged; D010359:Patient Readmission; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D012121:Respiration, Artificial; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*; D016540:Smoking Cessation; D000074606:Smoking Prevention; D019966:Substance-Related Disorders / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D013997:Time Factors
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