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Underner M, Peiffer G, Perriot J, Jaafari N. Republication de : Complications pulmonaires chez les consommateurs de cocaïne. JOURNAL EUROPÉEN DES URGENCES ET DE RÉANIMATION 2020; 32:127-141. [DOI: 10.1016/j.jeurea.2020.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Underner M, Peiffer G, Perriot J, Jaafari N. [Pulmonary complications in cocaine users]. Rev Mal Respir 2020; 37:45-59. [PMID: 31883817 DOI: 10.1016/j.rmr.2019.11.641] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 07/03/2019] [Indexed: 02/05/2023]
Abstract
Cocaine can be responsible for many psychiatric and/or somatic disorders. The aim of this systematic literature review of data was to expose relations between cocaine use and pulmonary complications. Cocaine can be responsible for acute respiratory symptoms (cough, black sputum, hemoptysis, dyspnea, wheezing, chest pain) and for various pulmonary disorders including barotrauma (pneumothorax, pneumomediastinum, subcutaneous emphysema, pneumopericardium), airway damage, asthma, bronchiolitis obliterans with organizing pneumonia, acute pulmonary edema, alveolar hemorrhage, alveolar pneumonia with carbonaceous material, bullous emphysema, acute eosinophilic pneumonia, pulmonary granulomatosis caused by talc or cellulose, interstitial pneumonitis and pulmonary fibrosis, vasculitis, pulmonary hypertension, pulmonary embolism and pulmonary infarction, mycotic pulmonary arterial aneurysms, septic emboli, aspiration pneumonia, community-acquired pneumonia, HIV-related opportunistic infections, latent tuberculosis infection, pulmonary tuberculosis, lung cancer and crack lung. Some of these complications are serious and may have a fatal outcome. Pulmonary function tests, thoracic tomodensitometry, bronchial fibroscopy with bronchoalveolar lavage and lung scintigraphy may be an aid to the diagnosis of these pulmonary compications. Cocaine use must be sought in case of respiratory symptoms in young persons.
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Affiliation(s)
- M Underner
- Unité de recherche clinique Pierre-Deniker, centre hospitalier Henri-Laborit, université de Poitiers, 370, avenue Jacques-Cœur, CS 10587, 86021 Poitiers cedex, France.
| | - G Peiffer
- Pneumologie, CHR Metz-Thionville, CHR Mercy, 57085 Metz cedex 3, France
| | - J Perriot
- Dispensaire Émile-Roux, centre de tabacologie, 63100 Clermont-Ferrand, France
| | - N Jaafari
- Unité de recherche clinique Pierre-Deniker, centre hospitalier Henri-Laborit, université de Poitiers, 370, avenue Jacques-Cœur, CS 10587, 86021 Poitiers cedex, France
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Underner M, Perriot J, Wallaert B, Peiffer G, Meurice JC, Jaafari N. [Alveolar hemorrhage and cocaine use]. Rev Mal Respir 2018; 35:134-148. [PMID: 29459175 DOI: 10.1016/j.rmr.2017.06.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 06/08/2017] [Indexed: 02/05/2023]
Abstract
In France, cocaine is the second most commonly illicit drug used after cannabis. Cocaine, mainly smoked in the form of crack, can be responsible for a wide range of respiratory disorders. The aim of this systematic literature review was to clarify what is known about the link between cocaine use and alveolar hemorrhage. We performed a Medline search covering the period 1980-2016 and collected data from 84 articles. The number of acute forms described in the literature is small but postmortem studies show that hidden forms are frequent. The diagnosis is based on the association of hemoptysis, anemia and diffuse alveolar opacity. Bronchoalveolar lavage shows hemosiderin-laden macrophages. Of the 13 cases identified, 12 patients had hemoptysis, anemia and diffuse alveolar infiltration on pulmonary or chest CT. In 9 cases, the presence of hemosiderin-laden macrophages was identified in bronchoalveolar lavage or pulmonary biopsy. Except for 2 deaths, the outcome was favorable when cocaine use was stopped. Systematic interventions to help people stopping using this psychoactive substance will protect lung health.
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Affiliation(s)
- M Underner
- Unité de recherche clinique intersectorielle en psychiatrie, consultation de tabacologie, centre hospitalier Henri-Laborit, 86000 Poitiers, France; Université de Poitiers, 86000 Poitiers, France.
| | - J Perriot
- Dispensaire Emile-Roux, centre de tabacologie, 63100 Clermont-Ferrand, France
| | - B Wallaert
- Service de pneumologie et immunoallergologie, centre de compétence maladies pulmonaires rares, hôpital Calmette, CHU de Lille, 59037 Lille, France
| | - G Peiffer
- Service de pneumologie, CHR Metz-Thionville, 57038 Metz, France
| | - J-C Meurice
- Service de pneumologie, CHU La Milétrie, 86021 Poitiers, France
| | - N Jaafari
- Unité de recherche clinique intersectorielle en psychiatrie, consultation de tabacologie, centre hospitalier Henri-Laborit, 86000 Poitiers, France; Université de Poitiers, 86000 Poitiers, France
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Underner M, Perriot J, Peiffer G. Pneumomédiastin et consommation de cocaïne. JOURNAL EUROPÉEN DES URGENCES ET DE RÉANIMATION 2017; 29:221-234. [DOI: 10.1016/j.jeurea.2017.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Underner M, Perriot J, Peiffer G. [Pneumomediastinum and cocaine use]. Presse Med 2017; 46:249-262. [PMID: 28189373 DOI: 10.1016/j.lpm.2017.01.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 11/30/2016] [Accepted: 01/05/2017] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION In France, cocaine is the second most commonly used illicit drug after cannabis. It can be responsible for many respiratory disorders among which pneumomediastinum. OBJECTIVES Systematic literature review of data on pneumediastinum in cocaine users. Documentary sources. Medline, on the period 1980-2016 with the keywords "pneumomediastinum" and "cocaine" or "free-base" or "freebasing" or "crack"; limits "title/abstract"; the selected languages were English or French. Among 72 articles, 48 abstracts have given use to a dual reading to select 37 studies. RESULTS Thirty-five selected articles related 44 subjects (sex-ratio: 5.2) whose age ranged from 15 to 36 years. Fourteen subjects used cocaine nasally and 30 others smoked it (12 as free-base and 18 in the form of crack). Thirty-two subjects had an isolated pneumomediastinum and 12 others had a pneumomediastinum combined with other gaseous effusions (pneumothorax, pneumopericardium, pneumoperitoneum or pneumorachis). Chest pain of sudden onset in the most common symptom which is often associated with tightness or swelling of the neck; more rarely there are dyspnea and/or a dry cough. The time between taking cocaine and the onset of the symptoms varies from a few minutes to 3 days. The course is usually good with healing in 1 to 4 days. CONCLUSION Cocaine use may be responsible for spontaneous pneumomediastinum. Practitioners must seek cocaine use in case of pneumomediastinum in a young person and consider the diagnosis in the case of sudden chest pain in cocaine users; they must help them to stop their consumption.
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Affiliation(s)
- Michel Underner
- Centre hospitalier Henri-Laborit, unité de recherche clinique, 86000 Poitiers, France.
| | - Jean Perriot
- Centre de tabacologie, dispensaire Émile-Roux, 63100 Clermont-Ferrand, France
| | - Gérard Peiffer
- CHR Metz-Thionville, service de pneumologie, 57038 Metz, France
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Abstract
Illicit stimulants, such as cocaine, amphetamine, and their derivatives (e.g., "ecstasy"), continue to exact heavy toll on health care in both developed and developing countries. The US Department of Health and Human Service reported over one million illicit drug-related emergency department visits in 2010, which was higher than any of the six previous years. Both inhaled and intravenous forms of these substances of abuse can result in a variety of acute and chronic injuries to practically every part of the respiratory tract, leading potentially to permanent morbidities as well as fatal consequences--including but not limited to nasal septum perforation, pulmonary hypertension, pneumothorax, pneumomediastinum, interstitial lung disease, alveolar hemorrhage, reactive airway disease, pulmonary edema, pulmonary granulomatosis, infections, foreign body aspiration, infections, bronchoconstriction, and thermal injuries. Stimulants are all rapidly absorbed substances that can also significantly alter the patient's systemic acid-base balance and central nervous system, thereby leading to further respiratory compromise. Mounting evidence in the past decade has demonstrated that adulterants coinhaled with these substances (e.g., levamisole) and the metabolites of these substances (e.g., cocaethylene) are associated with specific forms of systemic and respiratory complications as well. Recent studies have also demonstrated the effects of stimulants on autoimmune-mediated injuries of the respiratory tract, such as cocaine-induced midline destructive lesions. A persistent challenge to studies involving stimulant-associated respiratory toxidromes is the high prevalence of concomitant usage of various substances by drug abusers, including tobacco smoking. Now more than ever, health care providers must be familiar with the multitude of respiratory toxidromes as well as the diverse pathophysiology related to commonly abused stimulants to provide timely diagnosis and effective treatment.
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Affiliation(s)
- Will Tseng
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of California at Davis, School of Medicine and VA Northern California Health Care System, 4150 V Street, Suite 3400, Sacramento, CA, 95817, USA,
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Pascale A, Negrín A, Ormaechea R. Estudio preliminar de la repercusión pulmonar por consumo de pasta base de cocaína. Arch Bronconeumol 2011; 47:108. [DOI: 10.1016/j.arbres.2010.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2010] [Accepted: 08/06/2010] [Indexed: 10/18/2022]
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Griffard EA, Guajardo JR, Cooperstock MS, Scoville CL. Isolation of Exophiala dermatitidis from pigmented sputum in a cystic fibrosis patient. Pediatr Pulmonol 2010; 45:508-10. [PMID: 20425860 DOI: 10.1002/ppul.21187] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A 16-year-old female with cystic fibrosis (CF) presented with an acute respiratory exacerbation during which black flecks were observed in the spontaneously expectorated sputum. The production of this pigmented sputum was subsequently attributed to Exophiala dermatitidis hyphae. Treatment with antibiotics, corticosteroids, and antifungal medications led to an initial resolution of symptoms and clearance of the black pigment from her sputum. However, the patient again presented nine months later with reappearance of the pigmented flecks and concomitant clinical deterioration and was subsequently treated with an extended course of voriconazole. To the authors' knowledge, this is the first case report of fungal colonization by E. dermatitidis presenting as black flecks spontaneously expectorated in CF sputum.
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de Wit M, Gennings C, Zilberberg M, Burnham EL, Moss M, Balster RL. Drug withdrawal, cocaine and sedative use disorders increase the need for mechanical ventilation in medical patients. Addiction 2008; 103:1500-8. [PMID: 18636996 DOI: 10.1111/j.1360-0443.2008.002267.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS Alcohol use disorders increase the need for mechanical ventilation (MV) in critically ill medical, surgical and trauma patients. Studies examining other drug use disorders (DUD) in trauma patients have not demonstrated heightened rates of intensive care unit (ICU) complications. Patients with asthma and concurrent cocaine or heroin use disorders have an increased need for MV. The objective of this study is to determine if the presence of DUD and drug withdrawal syndromes are associated with increased need for MV in medical patients. DESIGN Analysis of a national database. SETTING The Nationwide Inpatient Sample, the largest all-payer in-patient database was utilized for the years 2002-2004. PARTICIPANTS Adult patients with one of the six common diagnoses associated with medical ICU admission were included. INTERVENTION None. MEASUREMENTS Univariate analysis and multivariate logistic regression were performed to determine if DUD and drug withdrawal were associated independently with the use of MV. FINDINGS A total 1 218 875 patients fulfilled one of the six diagnoses; 22 827 (1.9%) had DUD, and 102 841 (8.4%) underwent MV. Independent of the medical diagnosis, DUD was associated with an increased risk for requiring MV by univariate analysis (relative risk = 1.50, P < 0.0001). By multivariate analyses, sedative and cocaine use disorders remained associated with increased need for MV. Independent of medical diagnosis and substance, drug withdrawal was associated with increased odds of MV by both univariate and multivariate analysis (odds ratio = 2.94, P < 0.0001). CONCLUSIONS DUD are associated with increased need for MV in medical patients. This study demonstrates the importance of screening all medical patients for DUD.
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Affiliation(s)
- Marjolein de Wit
- Division of Pulmonary Disease and Critical Care Medicine, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA.
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Abstract
Sudden and unexpected natural deaths and nonnatural deaths may result from various pulmonary conditions. Additionally, several nonpulmonary conditions of forensic significance may be complicated by the development of respiratory lesions. Certain situations with pulmonary pathology are particularly likely to be critically scrutinized and may form the basis of allegations of medical negligence, other personal injury liability, or wrongful death.1
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Ksienski D, Malhotra S, Walker B, Levy RD. Chest Pain and Cough in a 33-Year-Old Postpartum Woman. Chest 2007; 132:1389-92. [DOI: 10.1378/chest.07-0480] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Restrepo CS, Carrillo JA, Martínez S, Ojeda P, Rivera AL, Hatta A. Pulmonary complications from cocaine and cocaine-based substances: imaging manifestations. Radiographics 2007; 27:941-56. [PMID: 17620460 DOI: 10.1148/rg.274065144] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Cocaine is the illicit drug whose abuse most often results in cardiopulmonary symptoms and emergency treatment. Habitual smoking of alkaloidal cocaine ("freebase," "crack") has replaced nasal insufflation as the most common method of abuse. Smoking of cocaine exposes the lung directly to the volatilized drug as well as to the other combustion products of the smoked mixture, thereby increasing the risk of adverse pulmonary effects. A wide variety of pulmonary complications including interstitial pneumonitis, fibrosis, pulmonary hypertension, alveolar hemorrhage, asthma exacerbation, barotrauma, thermal airway injury, hilar lymphadenopathies, and bullous emphysema may be associated with the inhalation of crack cocaine or of associated substances such as talc, silica, and lactose. Cocaine abuse represents one of the most serious medical and social problems of our time. Radiologists should be familiar with the various pleuropulmonary complications associated with the abuse of illicit drugs in general and of cocaine in particular to ensure correct diagnosis and appropriate treatment planning in patients with respiratory manifestations associated with such abuse.
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Affiliation(s)
- Carlos S Restrepo
- Department of Radiology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, MC 7800, San Antonio, TX 78229, USA.
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Abstract
CONTEXT Brazilian researchers have recently recognized a marked increase in the number of people using abusable drugs and the consequences of this habit. It has become a major public health problem in a potentially productive segment of the general population. In the last few years, several medical articles have given special emphasis to pulmonary complications related to cocaine use. This review is based on this information and experience acquired with groups of cocaine users. OBJECTIVE To present to physicians the pulmonary aspects of cocaine use and warn about the various effects this drug has on the respiratory system, stressing those related to long-term use. DESIGN Narrative review. METHOD Pulmonary complications are described. These may include infections (Staphylococcus aureus, pulmonary tuberculosis, acquired immunodeficiency syndrome/aids, etc.), aspiration pneumonia, lung abscess, empyema, septic embolism, non-cardiogenic pulmonary edema, barotrauma, pulmonary granulomotosis, branchiolitis obliterans and organizing pneumonia, pneumonitis and interstitial fibrosis, pneumonitis hypersensitivity, lung infiltrates and eosinophilia in individuals with branchial hyperreactivity, diffuse alveolar hemorrhage, vasculitis, pulmonary infarction, pulmonary hypertension and alterations in gas exchange. It is concluded that physicians should give special attention to the various pulmonary and clinical manifestations related to cocaine use, particularly in young patients.
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Affiliation(s)
- Mário Terra Filho
- Division of Pulmonary Diseases, Instituto do Coração and Laboratório de Investigação Médica (LIM-40), Department of Legal Medicine, Faculdade de Medicina, Universidade de São Paulo, Brasil.
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White SM, Lambe CJT. The pathophysiology of cocaine abuse. ACTA ACUST UNITED AC 2003; 10:27-39. [PMID: 15275044 DOI: 10.1016/s1353-1131(03)00003-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2002] [Accepted: 12/16/2002] [Indexed: 11/30/2022]
Abstract
Cocaine is a naturally occurring alkaloid that increases dopamine concentrations in the reward centers of the brain. There has been a marked increase in cocaine abuse over the last two decades. A neuropsychological stimulant, cocaine also reduces somnolence, increases alertness and improves concentration. However, cocaine abuse has many pathophysiological consequences. These fall broadly into four groups: pathology associated with a drug abusing lifestyle, pathology that occurs whilst intoxicated with (but not directly due to) the drug, pathology associated with drug administration and pathology resulting from pharmacological action of the drug. This review provides a detailed description of the physiological, pharmacological, and pathological effects of cocaine, and highlights the forensic and medicolegal implications of cocaine abuse.
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Affiliation(s)
- Stuart M White
- Department of Anaesthesia, St. Thomas' Hospital, London, UK.
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Abstract
Several substances besides tobacco are inhaled for recreational purposes, including marijuana, crack cocaine, amyl and butyl nitrites, heroin, methamphetamine, and phencyclidine. Abuse of most of these inhaled substances has risen in recent years, thereby increasing concern about potential pulmonary and other medical complications. Regular marijuana use can lead to extensive airway injury and alterations in the structure and function of alveolar macrophages, potentially predisposing to pulmonary infection and respiratory cancer. Crack cocaine use can lead to a variety of acute pulmonary complications, including severe exacerbations of asthma and an acute lung injury syndrome associated with a broad spectrum of histopathologic changes ("crack lung"). Habitual cocaine smoking may also produce more subtle long-term pulmonary consequences due to chronic alveolar epithelial and microvascular lung injury. Heroin inhalation can induce severe and even fatal exacerbations of asthma. Pulmonary consequences of inhaled amyl and butyl nitrites, crystalline methamphetamine (ice), and phencyclidine have been less well documented.
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Affiliation(s)
- D P Tashkin
- Division of Pulmonary and Critical Care Medicine, UCLA School of Medicine, Los Angeles, California 90095-1690, USA.
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Rome LA, Lippmann ML, Dalsey WC, Taggart P, Pomerantz S. Prevalence of cocaine use and its impact on asthma exacerbation in an urban population. Chest 2000; 117:1324-9. [PMID: 10807818 DOI: 10.1378/chest.117.5.1324] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
OBJECTIVES To assess the prevalence of cocaine use, and its impact on severity of presentation, among adults presenting to the emergency department (ED) with asthma. A secondary aim was to assess the use of various asthma treatment modalities, with reference to the 1997 National Asthma Education and Prevention Program (NAEPP) guidelines. METHODS All adults aged 18 to 55 years who presented to the ED of this institution with an asthma attack, were approached about participating in the study, which required giving informed consent, answering a facilitated questionnaire, and giving a urine sample for drug screening. RESULTS Patients were enrolled during a 7-month period. A total of 163 patients were approached to enter the study; 116 patients consented to participate in the study, with 103 submitting complete urine samples. Thirty-seven patients refused to participate, and 10 were excluded. Sixty-eight percent of the patients were women, with a mean age of 33 years. African-Americans made up 89% of the total group. Thirty-five percent were cigarette smokers. Urine cocaine tests were positive in 13 of 103 (13%); 6 of 103 (5.8%) were positive for opiates. In the cocaine-positive group, 5 of 13 patients (38%) were admitted to the hospital, including two patients requiring intubation and mechanical ventilation. Of the total group, 23 of 103 patients (22%) were admitted, and 5 of those 23 admitted patients (22%) were cocaine-positive. Length of stay was significantly longer (5 vs 2.5 days, p < 0.05) in the cocaine-positive admitted patients. Forty-six percent of all patients reported using inhaled corticosteroids (ICS), with 39% of admitted patients using them. Thirty-two percent of all patients had obtained three or more refills of their beta(2)-agonist inhaler in the previous month. CONCLUSIONS The prevalence of cocaine use may be much higher than the 13% shown in this study, because of patients' refusal to participate in the study. Second, the severity of exacerbation appears to be worse in the cocaine-positive group. Finally, the majority of patients presenting did not use ICS in accordance with the NAEPP guidelines.
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Affiliation(s)
- L A Rome
- Division of Pulmonary Medicine, Department of Medicine, Albert Einstein Medical Center, Philadelphia, PA 19141, USA
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Dicpinigaitis PV, Jones JG, Frymus MM, Folkert VW. "Crack" cocaine-induced syndrome mimicking sarcoidosis. Am J Med Sci 1999; 317:416-8. [PMID: 10372843 DOI: 10.1097/00000441-199906000-00011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A 39-year-old man with a history of frequent "crack" cocaine use of several years' duration presented with progressive dyspnea. Evaluation revealed bilateral interstitial pulmonary infiltrates and hilar adenopathy, diffuse pulmonary uptake of gallium, and markedly elevated serum angiotensin-converting enzyme activity. Open lung biopsy revealed interstitial and perivascular collections of histiocytes containing refractile, polarizable material, presumably inhaled along with the cocaine. Paratracheal lymph nodes were enlarged, reactive, and contained similar polarizable material. The well-formed, non-necrotizing granulomata characteristic of sarcoidosis were not present in either tissue specimen. To our knowledge, the association of chronic crack cocaine inhalation with this constellation of clinical findings, typically seen in sarcoidosis, has not previously been described.
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Affiliation(s)
- P V Dicpinigaitis
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA.
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Dicpinigaitis PV, Jones JG, Frymus MM, Folkert VW. "Crack" Cocaine-Induced Syndrome Mimicking Sarcoidosis. Am J Med Sci 1999. [DOI: 10.1016/s0002-9629(15)40556-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Cruz R, Davis M, O'Neil H, Tamarin F, Brandstetter RD, Karetzky M. Pulmonary manifestations of inhaled street drugs. Heart Lung 1998. [DOI: 10.1016/s0147-9563(98)90049-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Cruz R, Davis M, O’Neil H, Tamarin F, Brandstetter RD, Karetzky M. Pulmonary manifestations of inhaled street drugs. Heart Lung 1998. [DOI: 10.1016/s0147-9563(98)70001-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Affiliation(s)
- T E Albertson
- Department of Internal Medicine, University of California, Davis, Sacramento, USA
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Abstract
PURPOSE To review the medical complications of cocaine abuse and the mechanisms of action of cocaine that contribute to medical complications. DATA SOURCES Pertinent articles identified through a MEDLINE search of the English-language literature from 1985 to 1996 and through a manual search of bibliographies of all identified articles. STUDY SELECTION All articles describing complications of cocaine use including case reports, small reported series, and review articles. DATA SYNTHESIS A qualitative description of reported complications. RESULTS Since the introduction of freebase and crack cocaine, multiple medical complications have been observed, and all major body organ systems have been affected. Cocaine can cause acute strokes, myocardial infarction, cardiac dysrhythmias, pulmonary edema, rhabdomyolysis, and acute renal failure. CONCLUSION Adverse reactions to cocaine should be considered in the differential diagnosis of acute ischemic events that occur in young adults. General awareness of the significant complications of cocaine will facilitate early diagnosis and prompt treatment.
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Affiliation(s)
- M S Boghdadi
- Division of Cardiology, University of South Florida, Tampa, USA
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Osborn HH, Tang M, Bradley K, Duncan BR. New-onset bronchospasm or recrudescence of asthma associated with cocaine abuse. Acad Emerg Med 1997; 4:689-92. [PMID: 9223692 DOI: 10.1111/j.1553-2712.1997.tb03761.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To determine whether the occurrence of new-onset bronchospasm or the recrudescence of asthma is associated with the use of cocaine. METHODS A consecutive sample of patients presenting to an inner-city adult ED with new-onset bronchospasm or recrudescence of bronchospasm after > 5 years were prospectively enrolled in a case-control prevalence study. The bronchospasm patients were queried as to their exposure to illicit drugs, and urine was obtained to screen for cocaine and its metabolite, benzoylecgonine. An age- and sex-matched control group was composed of randomly chosen subjects without respiratory complaints or a history of asthma. The control group was also screened by urine toxicology for cocaine and its metabolite, benzoylecgonine. RESULTS In the asthma group, 21/59 (36%) had a urine toxicologic screen positive for cocaine metabolite (benzoylecgonine). Of the 21 with a positive screen for cocaine, 8 denied illicit drug abuse. Among the 13 patients reporting drug use, 10 said that they smoked crack and 3 snorted cocaine. In the control group, 8/53 (15%) were positive. Multivariate logistic regression analysis, with adjustment for age and sex, indicated that the use of cocaine was associated with a 3-fold higher prevalence of new-onset bronchospasm or recrudescence of asthma (OR = 3.28, 95% CI: 1.26 to 8.50). CONCLUSIONS There appears to be an association between cocaine use and new-onset bronchospasm or recrudescence of asthma in this inner-city ED population. Further study is necessary to determine the basis for this association.
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Affiliation(s)
- H H Osborn
- New York Medical College, Lincoln Medical and Mental Health Center, Department of Emergency Medicine, Bronx 10457, USA.
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Wang Y, Green LK, Rodriguez-Barradas MC. An HIV-infected man with cough and black sputum. Hosp Pract (1995) 1996; 31:122-4. [PMID: 8969685 DOI: 10.1080/21548331.1996.11443396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Y Wang
- Veterans Affairs Medical Center, Houston, USA
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Tashkin DP, Kleerup EC, Koyal SN, Marques JA, Goldman MD. Acute effects of inhaled and i.v. cocaine on airway dynamics. Chest 1996; 110:904-10. [PMID: 8874243 DOI: 10.1378/chest.110.4.904] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Wheezing has been reported by 32% of habitual smokers of crack cocaine, and several cases of crack-related acute exacerbations of asthma have been reported. STUDY OBJECTIVE To compare the acute effects of physiologically active doses of smoked cocaine base and, i.v. cocaine hydrochloride (HCl), a subphysiologic dose of cocaine base (smoked "placebo"), and i.v. saline solution placebo on bronchomotor tone, subjective level of intoxication, and cardiovascular responses in healthy habitual crack users. DESIGN A single-blind crossover study in which the order of route of administration (inhaled vs i.v.) was random but placebo always preceded the active drug. SUBJECTS Fourteen healthy, nonasthmatic current crack-smoking subjects, 34 to 48 years of age, with a history of previous i.v. cocaine use (1 to 12 times per lifetime). METHODS Heart rate, BP, self-rated level of intoxication (scale of 0 to 10), and measurements of airway resistance (Raw) and specific airway conductance (SGaw) were recorded during separate sessions before and 3 to 5, 10, 15, and 30 min after administration of smoked cocaine base (38.5 +/- 2.3 [SEM] mg), smoked placebo (2.3 +/- 0.9 mg cocaine base), i.v. cocaine HCl (30.0 +/- 2.0 mg), and i.v placebo (saline solution). RESULTS Both smoked active cocaine and i.v. cocaine HCl caused comparable, significant (p < 0.05) peak levels of acute intoxication (6.7 +/- 0.7 and 7.3 +/- 0.8, respectively) and increases in heart rate from baseline (29.6 +/- 2.9% and 21.4 +/- 3.7%, respectively, at 5 min). However, only smoked active cocaine caused significant decreases from baseline in SGaw (25.4 +/- 6.3% at 5 min), in contrast to nonsignificant changes after i.v. cocaine HCl (5.6 +/- 7.0% increase) and smoked placebo (10.2 +/- 6.0% decrease). CONCLUSIONS Smoked cocaine base, but not systemically administered cocaine HCl, causes acute bronchoconstriction that is probably mediated by local airway irritation and could account for reports of crack-induced wheezing and asthma attacks in nonasthmatic and asthmatic individuals, respectively.
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Affiliation(s)
- D P Tashkin
- Department of Medicine, UCLA School of Medicine 90024, USA
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Singh B, Greenebaum E, Cole R. Carbon-laden macrophages in pleural fluid of crack smokers. Diagn Cytopathol 1995; 13:316-9. [PMID: 8599915 DOI: 10.1002/dc.2840130408] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Carbon-laden macrophages in bronchoalveolar lavage have been noted to be associated with a history of crack smoking. We report herein the finding of carbon-laden macrophages in four cytological preparations of pleural fluid from two crack smokers. The etiology of the two patients' pleural effusions differed; neither had a bronchopleural fistula. Patient 1 had AIDS, Pneumocystis carinii pneumonia, and Kaposi's sarcoma of the right lung with an associated bilateral pleural effusion. Patient 2 was HIV seropositive, had pulmonary tuberculosis, hepatitis A, B, and C, cardiomyopathy, pulmonary embolism, and bilateral pleural effusions, the latter of which were probably due to cardio-pulmonary dysfunction. An additional two crack smokers with pleural effusions due to malignancy, one primary pulmonary adenocarcinoma and the other metastatic melanoma, did not have carbon-like material in their pleural fluid cytology. We hypothesize that intracellular accumulation of carbonaceous material in the lung parenchyma and pleural space occurs when normal clearance mechanisms are overwhelmed.
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Affiliation(s)
- B Singh
- Department of Pathology, College of Physicians and Surgeons of Columbia University, New York, NY 10032, USA
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Affiliation(s)
- T E Albertson
- Department of Internal Medicine, School of Medicine, University of California, Davis, USA
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Haim DY, Lippmann ML, Goldberg SK, Walkenstein MD. The pulmonary complications of crack cocaine. A comprehensive review. Chest 1995; 107:233-40. [PMID: 7813284 DOI: 10.1378/chest.107.1.233] [Citation(s) in RCA: 132] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Affiliation(s)
- D Y Haim
- Temple University Hospital and Albert Einstein Medical Center, Division of Pulmonary/Critical Care Medicine, Philadelphia, PA 19141
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