الفهرس 
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Abstract
Background
Chronic obstructive pulmonary disease (COPD) is a common community problem and considered an essential cause of morbidity and mortality in both developed and developing countries. COPD was expected to be the third leading cause of death by 2020 (Mannino and Buist, 2007 and Lopez et al., 2006). Drug addiction is a chronic, relapsing disorder in which compulsive drug-seeking and drug-taking behavior persists despite serious negative consequences (Maddux and Desmond, 2000). Tolerance and physical dependence reflect physiological adaptation to the effects of a drug, whereas the remaining criteria define uncontrollable drug consumption. However, tolerance and physical dependence are neither necessary nor sufficient for a diagnosis of substance dependence. Substance abuse or harmful use, a less severe disorder, may result in dependence (World Health Organization, 1992). Smokers with COPD are at high risk for poor health outcomes directly attributable to tobacco related conditions, including progression of lung disease and cardiovascular diseases (Mullerova et al., 2013). Cannabis, commonly known as marijuana, is the most widely used illegal drug in the world. After tobacco, it is the second most widely smoked substance in the general population (World Drug Report 2006).
Aim of the study:
This study was conducted to detect different patterns of addiction in COPD patients admitted in Abbasia Chest Hospital, and to evaluate the effect of substance abuse in disease course.
Subjects and methods:
After IRB ethical approval, all patients with diagnosed COPD by either spirometery or past medical history in Abbasiya Chest Hospital from August 2018 to January 2019 attending outpatient clinic, ER or being admitted to either ward or ICU with drug abuse were eligible to be selected in this study after taken an informed consent from them. All included patients underwent spirometry and other confirmatory diagnosis of COPD and addiction. The addiction questionnaire also was filled from all participants. Data was entered and analyzed by SPSS.
Results:
The study included 100 male patients with COPD on substances abuse. Their age ranged from 27 to 74 years with mean 52.84 ± 10.21 years and 15% overweight. More than half of them had no comorbidities, 17% had DM and HTN and 19% had HTN. Seventy six percent of them were heavy smokers and 24% were moderate smokers. The most prevalent substance addicted by the participants was Hashish (cannabis) alone (70%) followed by Hashish with tramadol in (25%) of cases then IV substances in (3%) and lastly (2%) were on Heroin.
Most of the studied patients (73%) had addictive behavior and only (27%) had no addictive behavior. As regard the CAT assessment of GOLD COPD Guidelines, there were 9% with Score I, 17% with Score II, 44% with Score III and 30% with Score IV. Concerning the effect of the substance abuse on the disease course, there were 29% of the patients admitted to the ICU once, 41% were admitted twice and 11% were admitted three times from the beginning of addiction till the recruitment in the study also patients with higher possibility to have addictive behavior were more susceptible to higher ICU admission rate.
Regarding the effect of the substance abuse on the pulmonary function tests, there were a negative impact of the substance on the pulmonary function test as follows; mean FEV1%, FVC%, FEV1/ FVC and FEF25-75% were 40.9±18.8, 52.7±21.5, 58.9±7.6 and 23.3±14.3 for all parameters, respectively. Also, there was a significant negative association between the addiction behavior and the low pulmonary function tests.