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SAN FRANCISCO -- The prevalence of asthma was more than twice as high as the national average in a cohort of opioid-dependent patients receiving acute care at an inner city hospital in a New York City borough, with female sex more closely linked to higher asthma risk than male sex, researchers reported here.

The overall asthma prevalence among the opioid-dependent patients treated in the acute care unit of Kings County Hospital Center in Brooklyn was 17.2%, while the national prevalence among adults is , according to the CDC, reported Roshni Naik, MD, of SUNY Downstate Medical Center in New York City, and colleagues.

Naik's group presented two studies at the American Academy of Allergy, Asthma & Immunology annual meeting: One looked at the prevalence of asthma in chronic opioid users who received acute care in an inner city, municipal New York hospital, and one that evaluated the prevalence of long-term opioid use in patients with asthma and allergic rhinitis.

In one study cohort, 25% of opioid-dependent women in the study had asthma, versus a national average asthma rate of 9.7% among women, she said.

Naik said in vitro studies suggest opioids promote a type 2 helper T cell response in the immune system that has been linked to asthma.

"Opioid drugs, like morphine, can directly activate the release of histamine, and histamine elicits the allergic response that causes itching and hives," she said. "Since more than half of asthma is allergic in nature, we postulated that opioids may be linked to asthma."

However, studies evaluating the effects of opioid use on asthma risk in the clinical setting have been mixed.

"While some studies have shown that some opioids can help shortness of breath in heart disease and advanced COPD [chronic obstructive pulmonary disease], other studies have shown that opioids like heroin have worsened asthma and contributed to asthma hospitalization," Nair said. "We hypothesized that there would be an increased prevalence of asthma in patients with chronic opioid-dependence in King's County Hospital in Brooklyn, New York. This hospital serves a large, inner city, minority patient population."

The researchers performed a cross-sectional data analysis retrospective chart review of adult patients treated in inpatient, emergency department, and ambulatory surgery settings at the hospital from 2013 through 2017.

ICD coding for opioid abuse/dependence, chronic pain conditions (chronic pain syndrome, osteoarthritis, joint disorder, fibromyalgia), asthma, and allergic rhinitis were obtained, and opioid prescriptions were used to determine the percentage of patients who had asthma/allergic rhinitis and were chronic users of opioids.

Among patients with opioid abuse/dependence (n=1,977), 18% had asthma. There were more males than females in patients with opioid abuse/dependence without asthma (73% vs 27%) and with opioid abuse/dependence with asthma (56% vs 44%, Chi square analysis, P<0.001).

Among patients with chronic pain conditions (n=3,259), 7% had asthma, and <1% had allergic rhinitis.

Females outnumbered males among patients with chronic pain conditions without asthma (64% vs 36%) and among patients with chronic pain conditions with asthma (75% vs 26%, Chi square analysis P<0.05).

Among patients with chronic pain conditions and asthma/allergic rhinitis, 51% had opioid prescriptions. A total of 68% of opioid prescriptions occurred among females.

"These findings suggest that women who are opioid dependent are disproportionately affected by asthma," Naik said. "The reasons for this are unclear, but studies have shown that women are more likely than men to report chronic pain conditions and are therefore prescribed opioid medications more for pain compared to men."

Naik noted that there are no current guidelines instructing clinicians on how to manage patients on opioid medications who also have asthma.

She said patients with severe asthma should follow up regularly with their primary care doctor or see an asthma specialist to maintain control of their disease.

"Also, any patients who have opioid addiction or dependence should see a healthcare provider to address their addiction," she said.

Study limitations were the fact that it was done at a single center with mostly economically disadvantaged patients and the acute care focus.

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