Adam Monsell

Respiratory outreach clinic within substance misuse services

Those attending substance misuse services have high rates of undiagnosed respiratory disease. Clients attend substance misuse services more readily than other healthcare settings. We aimed to capitalise on this attendance, and offer assessment, testing, education and advice for breathless patients by a respiratory physician from a partner physical healthcare trust.

Case finding criteria were agreed with the respiratory team. Clients attending assessments at substance misuse were screened. Clients attending the clinic received a structured assessment by a respiratory physician, spirometry, explanation of findings and advice, with onward referral via their GP or stop smoking services. Clients were screened with a pre- and post-attendee questionnaire to assess their understanding and impact, and were followed up by telephone at 4 months.

62 of 130 clients screened (48%) met criteria for the clinic. 15 clinics were held, with 33 service users attending 44 appointments offered. A new diagnosis of chronic obstructive pulmonary disease (COPD) was made in 14 clients (42%). A mixed asthma/COPD picture was seen in 3 patients. 4 clients had other respiratory diagnoses suspected. One service user was referred onwards because of suspected malignancy. 18 clients responded to four-month follow-up. Stop smoking services were actively working with 13 patients. 8 had given up smoking tobacco and a further 5 had cut down. 4 service users had reduced, or stopped smoking other substances.

A respiratory outreach clinic helps identify respiratory disease that may otherwise go undiagnosed, or present late. It may also have an impact on tobacco dependence among substance misuse clients.
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