What are the pulmonary complications of cocaine (cocaine hydrochloride) use?

From the Guidelines

Cocaine use can lead to several serious pulmonary complications, including "crack lung," a syndrome characterized by diffuse alveolar damage, pulmonary hemorrhage, and respiratory failure, as well as pneumothorax, pneumomediastinum, pulmonary edema, and increased susceptibility to respiratory infections. The most common respiratory issues include acute respiratory symptoms like cough, wheezing, shortness of breath, and chest pain, which can occur immediately after use 1. Cocaine can cause these complications due to its vasoconstrictive properties, direct toxic effects on lung tissue, contaminants in the drug, and the method of administration (smoking, snorting, or injecting) 1.

Some of the key pulmonary complications of cocaine use include:

• "Crack lung," a syndrome characterized by diffuse alveolar damage, pulmonary hemorrhage, and respiratory failure
• Pneumothorax (collapsed lung) and pneumomediastinum (air in the chest cavity) due to increased intrathoracic pressure from smoking techniques or barotrauma
• Pulmonary edema from direct toxic effects on the alveolar-capillary membrane or from cardiovascular complications
• Chronic cocaine use is associated with pulmonary hypertension, interstitial lung disease, and bronchiolitis obliterans
• Increased susceptibility to respiratory infections, including pneumonia and tuberculosis, due to immunosuppressive effects and damage to respiratory defenses

Treatment typically involves cessation of cocaine use, supportive care, and addressing specific complications as they arise 1. It is essential to prioritize the patient's morbidity, mortality, and quality of life when managing these complications.

The most recent and highest quality study on this topic is from 2017, which highlights the importance of risk stratification and management of patients with cocaine-associated chest pain in an observation unit 1. The management of cocaine-associated chest pain and myocardial infarction should involve sublingual NTG or a calcium channel blocker, and immediate coronary angiography should be performed if possible. Fibrinolytic therapy may be employed in patients with MI after cocaine use, although PCI may be a preferred method of revascularization in this setting 1.

In conclusion, the pulmonary complications of cocaine use are severe and can be life-threatening. It is crucial to prioritize the patient's morbidity, mortality, and quality of life when managing these complications, and to follow the most recent and highest quality guidelines for treatment.

From the Research

Pulmonary Complications of Cocaine Use

The pulmonary complications of cocaine use are numerous and can be severe. Some of the complications include:

• Infections such as Staphylococcus aureus, pulmonary tuberculosis, and acquired immunodeficiency syndrome (AIDS) 2
• Aspiration pneumonia, lung abscess, empyema, septic embolism, non-cardiogenic pulmonary edema, barotrauma, pulmonary granulomotosis, and branchiolitis obliterans with organizing pneumonia 2
• Pneumonitis and interstitial fibrosis, pneumonitis hypersensitivity, lung infiltrates, and eosinophilia in individuals with branchial hyperreactivity 2
• Diffuse alveolar hemorrhage, vasculitis, pulmonary infarction, pulmonary hypertension, and alterations in gas exchange 2
• Acute respiratory symptoms such as cough, black sputum, hemoptysis, dyspnea, wheezing, and chest pain 3
• Barotrauma, airway damage, asthma, bronchiolitis obliterans with organizing pneumonia, acute pulmonary edema, alveolar hemorrhage, and alveolar pneumonia with carbonaceous material 3
• Bullous emphysema, acute eosinophilic pneumonia, pulmonary granulomatosis caused by talc or cellulose, interstitial pneumonitis, and pulmonary fibrosis 3
• Vasculitis, pulmonary hypertension, pulmonary embolism, pulmonary infarction, mycotic pulmonary arterial aneurysms, septic emboli, aspiration pneumonia, and community-acquired pneumonia 3
• HIV-related opportunistic infections, latent tuberculosis infection, pulmonary tuberculosis, and lung cancer 3
• Upper respiratory and pulmonary complications such as ischemia, necrosis, and infections of the nasal mucosa, sinuses, and adjacent structures 4
• Pulmonary edema, pulmonary hemorrhages, pulmonary barotrauma, foreign body granulomas, cocaine-related pulmonary infection, obliterative bronchiolitis, and asthma 4
• Persistent gas-exchange abnormalities and severe respiratory difficulties in neonates of abusing mothers 4
• Interstitial pneumonitis, fibrosis, pulmonary hypertension, alveolar hemorrhage, asthma exacerbation, barotrauma, thermal airway injury, hilar lymphadenopathies, and bullous emphysema 5
• Cocaine-induced asthma and "crack lung" syndrome, which can elicit new-onset and exacerbate chronic pulmonary conditions 6

Diagnosis and Treatment

Diagnosis of pulmonary complications related to cocaine use can be aided by pulmonary function tests, thoracic tomodensitometry, bronchial fibroscopy with bronchoalveolar lavage, and lung scintigraphy 3. Treatment of these complications may involve the use of bronchodilators, steroids, and oxygen therapy, as well as abstaining from cocaine use 6.