Over the last 20 years smoking has become the most common method of heroin use and increasing numbers of heroin smokers are presenting to local medical services, before the age of 40 years, with severe airway disease. To determine COPD prevalence we recruited 129 subjects from two local community drug services, of whom 107 were heroin smokers. We collected demographic, medical and treatment data, smoking history (including cannabis and opiates) and details of symptoms including MRC dyspnoea. Subjects completed the COPD Assessment Tool and spirometry. Thirty heroin smokers were identified as having COPD resulting in a COPD prevalence of 28%. Mean age was 43 (4) years and FEV1 was 2.71 (0.98) L; 70 (23) %predicted. Breathlessness and wheeze were more common in subjects with COPD (p < 0.04 and p < 0.05) but symptoms were common in all heroin smokers. MRC score was higher (3 vs. 2.4; p < 0.04) in those with COPD and health status appeared poorer (CAT 20.4 vs. 15.8; p < 0.07). Only 4 (11%) had previously been diagnosed with COPD and only 16 (53%) received any inhaled medication. Asthma prevalence was also high at 33% and asthmatic subjects had similar symptoms and health status compared with the COPD subjects, and were also significantly undertreated. COPD and asthma are common in current and former heroin smokers. They are often present at a young age and are underdiagnosed and undertreated. Awareness of this issue should be highlighted within drug services and in particular to heroin smokers. Screening this high-risk population with spirometry should be considered.

In the 1990s inhalation ('chasing the dragon') became the predominant method of recreational opiate (heroin and crack cocaine) consumption as it was perceived to have fewer detrimental health effects than injection. Although clinicians encounter individuals with COPD associated with opiate smoking ('heroin lung') the airway effects and symptoms resulting from opiate smoking are not established. We recruited 145 current and past opiate users from a local community drug service and recorded demographics. They completed spirometry pre and post salbutamol and questionnaires addressing drug use, symptoms and health status. Lower limit of normal was used to define airflow obstruction. Ten subjects failed to produce adequate spirometry, 26 had only injected and never smoked opiates while 6 subjects had marked bronchodilator (BD) reversibility consistent with asthma. Thirty six subjects appeared to have COPD and these were compared with 67 opiate smokers with normal post-BD spirometry and the 26 subjects who only injected opiates. The results from the 3 groups are shown in the table. The COPD group was a little older and necessarily had a lower FEV1 and post-BD airflow obstruction. There was little difference in length of drug use when the opiate smokers with COPD were compared to those without and the frequency of cough and phlegm differed little. Opiate smokers with COPD had modestly higher rates of wheeze and breathlessness; hence, higher CAT and MRC dyspnoea scores, but respiratory symptoms and use of respiratory medication were common in the non-COPD groups. Heroin and crack cocaine smoking is a risk factor for the development of irreversible airflow obstruction at a very young age. Respiratory symptoms are common in opiate smokers irrespective of the presence of COPD and not uncommon in those who have only injected opiates. In many, this is associated with a reduced health status despite normal spirometry; hence, symptoms are not a useful way to 'diagnose' COPD and spirometry is essential. P124 CHRONIC BRONCHITIS AMONG FISHERMEN IN EXPOSED TO FIREWOOD SMOKEVA Umoh; University of Uyo Teaching Hospital, Uyo, Nigeria 10. 1136/thoraxjnl-2013-204457.274 Background Biomass is heavily depended on for domestic energy use by people in developing countries. These materials are typically burnt in simple stoves and produce a lot of smoke. Exposure to this indoor air pollution has been linked to a number of respiratory disorders. This study aimed to assess some long term effects exposure to indoor air pollution among fishermen. Methods A survey was conducted in a fishing community in Nigeria among 337 fishermen exposed to indoor air pollution from burning firewood and 345 matched controls. Exposure was determined by the product of the average daily duration of time spent close to the fire and the number of years (Hour-years). A modified BMRC questionnaire was used to obtain information on respiratory symptoms and spirometry was performed on the participants. Results The frequency of chronic respiratory symptoms was signific...

decline of -8% (p = 0.03). In contrast, there were no significant differences in FEV 1 responses in volunteers with COPD, though there was a mean drop in FVC of -8% (p = 0.03) two hours after the start of exposure in Oxford street compared to Hyde Park. We recorded no changes in arterial stiffness in either group for either exposure site. Conclusions These early findings suggest that the observations made in healthy volunteers from chamber studies can be replicated in ambient conditions. The apparent lack of any respiratory response in patients with COPD may reflect their upregulated baseline inflammatory state, or systematic differences in the exposure differential between the two sites. We continue to recruit volunteers; further measurements including markers of oxidative stress in sputum, serum, and small airways impedance are under way.Funded by the British Heart Foundation. Background Screening for A1AT-deficiency at our institution involves serum protein assay, then phenotyping where A1AT≤1.1g/L. RT-PCR genotyping for S/Z variants is available for clarification. We recently established a multi-disciplinary respiratory/hepatology London A1AT Deficiency Service and reexamined the cost-effectiveness of our diagnostic algorithm. Method We studied all patients who had a serum A1AT request over the three years 1/1/2010-31/12/2012. We went on to examine all requests for phenotyping and/or genotyping over the ten years 1/1/2003-31/12/2012. Results From 4460 requests over 2010-2012, 240(5.4%) had serum A1AT≤1.1g/l. Of these, phenotyping was not available in 33 and of the remainder the following phenotype-prevalence data were observed (n,%): MM (75,36%), MZ (89,43%), MS (29,14%), ZZ (6,3%), SZ (6,3%), SS (1,1%), GM (1,1%). In error, 28 patients had phenotyping with A1AT>1.1g/l: 27 were PiMM and 1 PiMS. Over 2003-2012, 525 phenotyping tests were performed. In 41 the result was unclear or there was evidence of in vivo degradation. The prevalence of the respective phenotypes and mean (SD) A1AT concentrations are reported in the Table. Over the same period, 24 equivocal samples were sent for genotyping. This confirmed 13 = PiMM, 4 = PiZZ, 3 = PiMZ, 2 = PiMS and 2 = PiSZ. P121 COST-EFFECTIVENESS OF ALPHA-1 ANTITRYPSIN (A1AT) DEFICIENCY CASE-FINDING IN SECONDARY CAREThe NHS costs of A1AT serum assay, phenotyping and genotyping are £2.45, £35.50 and £87.50. Using the 2010-2012 data, our mean annualised spend on A1AT serum, phenotyping and genotyping was £3,642 £3,170 and £376 respectively. The cost per ZZ/SZ case diagnosed was £1198.The highest A1AT serum concentration recorded in the ZZ/ SZ patients were 0.4 and 1.0g/l respectively suggesting that the ≤1.1g/l cut-off is appropriate. The specificity, sensitivity and positive predictive values are 26.5%, 100% and 6.5%. Conclusion 5.4% of serum A1AT assays yielded results ≤1.1g/l. Of these, 6% were found to represent SZ/ZZ variants at risk of clinically relevant disease (0.27%, 1/372 requests). The ≤1.1g/l cut-off was 100% sensitive but only 26.5% specific for clinically rel...