heroin and Asthma

A review of the evidence was conducted regarding asthma associated with the use of cocaine, heroin, and marijuana.. A search of the English literature was performed via PubMed/Medline and EMBASE using the search terms asthma AND cocaine, heroin, and marijuana. When pertinent articles were found, salient references in those articles were assessed.. Due to the relatively small number of studies, we included all studies and cases.. For several decades, case reports, retrospective studies, and laboratory investigations have demonstrated that inhalation of cocaine or heroin is associated with increased asthma symptoms and reduced pulmonary function. Smoking crack cocaine, nasal insufflation of cocaine or heroin, and smoking heroin increases the risk of emergency department visits and hospitalizations for asthma. Although frequent smoking of marijuana may cause symptoms of cough, sputum production, and wheezing in the general population, more studies are needed specifically in patients with asthma. Smoking marijuana with concomitant tobacco use is common and further worsens the respiratory symptoms.. Use of cocaine and heroin in patients with asthma should be avoided. Pending further studies, it would be prudent for patients with asthma to avoid smoking marijuana. Clinicians need to be vigilant regarding use of these drugs in their patients with hyperreactive airway disease.

Topics: Administration, Inhalation; Asthma; Cannabis; Cocaine-Related Disorders; Crack Cocaine; Heroin; Heroin Dependence; Humans; Marijuana Abuse; Marijuana Smoking; Respiratory Function Tests; Respiratory Sounds; Retrospective Studies; Substance-Related Disorders

Heroin addiction may increase the risk of pulmonary involvement. We describe the case of a 23 year-old woman who was admitted to our unit for severe asthma attack non responsive to beta-2-agonists and acute respiratory failure, soon after heroin inhalation. The patient was successfully treated with non invasive positive pressure ventilation. Opiate inhalation can be an asthma trigger and should be considered in the care of patients with poorly controlled asthma and life-threatening asthmatic attacks.

Topics: Administration, Inhalation; Adolescent; Asthma; Female; Heroin; Heroin Dependence; Humans; Young Adult

Topics: Administration, Intranasal; Administration, Oral; Adrenal Cortex Hormones; Adult; Asthma; Disease Progression; Heroin; Heroin Dependence; Humans; Male; Severity of Illness Index

Topics: Acute Disease; Administration, Inhalation; Adult; Asthma; Eosinophilia; Female; Heroin; Heroin Dependence; Humans; Male; Narcotics

Topics: Administration, Inhalation; Asthma; Heroin; Heroin Dependence; Humans; Naloxone; Narcotic Antagonists; Substance Withdrawal Syndrome

To determine the prevalence of self-reported, heroin-associated asthma symptoms among inner-city patients treated for life-threatening asthma, and to compare the rates of drug use between ICU patients with asthma and ICU control patients with diabetic ketoacidosis (DKA).. Study 1 was a sequential case series of patients requiring ICU admission for asthma (January to June 1999). Study 2 was a retrospective, case-control study of drug use among asthma patients and control subjects with DKA requiring ICU care (1997 to 1998).. Inner-city, public hospital ICU.. Twenty-three patients (26 ICU admissions) with asthma (age range, 16 to 50 years) admitted to the ICU from January to June 1999, and 84 patients (104 ICU admissions) with asthma and 42 patients with DKA (age range, 15 to 50 years) admitted to the ICU during 1997 to 1998. Outcomes studied: Self-reported, heroin-associated exacerbations, history of heroin or cocaine use, and urine drug screen (UDS) results.. In the sequential ICU admissions, 13 of 23 patients (56%) described asthma exacerbations associated with heroin insufflation. In the case-control study, asthmatics were significantly more likely to report heroin use (41.3% vs 12.5%; p = 0.006) and had a significantly higher prevalence of UDS results positive for opiates (60% vs 7%; p = 0.001) compared to subjects with DKA. The rates of cocaine use by history and UDS results did not differ significantly between the two groups.. At least since 1997, heroin insufflation is a common asthma trigger in this inner-city ICU and should be considered in the care of patients with life-threatening asthma.

Topics: Adolescent; Adult; Asthma; Case-Control Studies; Chicago; Cocaine-Related Disorders; Cross-Sectional Studies; Diabetic Ketoacidosis; Female; Heroin; Heroin Dependence; Humans; Intensive Care Units; Male; Middle Aged; Patient Admission; Retrospective Studies; Substance Abuse Detection; Urban Population

The value of skin prick testing in opiate-sensitive individuals is uncertain as opiates cause non-specific weals by direct degranulation of mast cells.. To define whether skin prick test (SPT) responses to opiates in opiate-sensitive individuals are different to those seen in the normal population and to describe the clinical characteristics of this group of subjects.. The SPT responses of eight opiate-sensitive subjects to morphine 10 mg/mL, pethidine (meperidine) 50 mg/mL and papaveretum 15.4 mg/mL at four different concentrations (undiluted, 1/10, 1/50 and 1/100) were compared with the responses of 100 (32 atopic) non-opiate-sensitive control subjects. Four of the opiate-sensitive subjects had a clinical history of asthma, rhinitis or urticaria on occupational exposure to morphine. One subject developed urticaria with codeine, one developed urticaria and asthma with morphine and diamorphine and two subjects reacted to intravenous papaveretum with anaphylaxis or urticaria. Five out of the eight cases had opiate sensitivity confirmed by single-blind placebo-controlled oral challenge.. Skin prick tests to all three opiates were not significantly different when the eight opiate-sensitive subjects were compared with either the entire normal control group or the subgroup of 47 definite opiate-tolerant controls that had previously received opiates for clinical indications. Furthermore, there were no significant differences in size of opiate SPT responses between atopic and non-atopic control subjects. In the control subjects, there was a positive correlation in SPT weal size between the three opiates.. Skin prick testing is not useful in the diagnosis of opiate sensitivity and placebo-controlled challenge should be considered.

Topics: Adult; Aged; Aged, 80 and over; Allergens; Asthma; Codeine; Drug Hypersensitivity; Female; Heroin; Humans; Male; Meperidine; Middle Aged; Morphine; Narcotics; Occupational Diseases; Opium; Rhinitis; Skin Tests; Urticaria

Comprehensive investigation is necessary for determining the cause of death in cases with positive drug screens. We investigated the case of a male who reportedly expired from an acute asthma attack. He had limited access to both therapeutic drugs and drugs of abuse because he was a state prisoner. His autopsy was remarkable because the weights of his right and left lungs were 690 and 760 g, respectively. His upper airway was clear of debris. There was an abundant amount of blood and frothy fluid in the pulmonary parenchyma. There were no focal lesions. The pulmonary vasculature was unremarkable. Microscopic evaluation of the lung tissue showed that the bronchi contained dense inflammatory infiltrates consisting mostly of eosinophils and a few lymphocytes and plasma cells. Basement membrane thickening was evident in the bronchi, and mucous plugs were identified in some of the bronchial lumina. A morphine concentration of 80 ng/mL was found in the blood. Theophylline and albuterol were detected in trace amounts. The opinion of the coroner was that the patient died of an acute asthma attack, and the presence of morphine may have contributed to his death. A careful review of his medical history and the mechanisms of drug-induced asthma revealed that the etiology of his death was more likely due to heroin abuse and noncardiogenic pulmonary edema. Episodic exacerbations of his chronic asthma were a contributing factor in his demise. However, in and of itself, asthma was not responsible for his death. Pertinent information associated with this case is presented, along with additional findings of toxicological screens and other evidence demonstrating that his asthma treatment did not contribute to his death. In addition, opiate-induced asthma, as well as other drug-induced diseases that can contribute to mortality in patients who abuse narcotics, is reviewed.

Topics: Administration, Inhalation; Adult; Albuterol; Asthma; Fatal Outcome; Heroin; Humans; Lung; Male; Morphine; Pulmonary Edema; Rhinitis, Allergic, Perennial; Substance-Related Disorders; Theophylline

Topics: Administration, Inhalation; Adult; Asthma; Heroin; Heroin Dependence; Humans; Male

Topics: Administration, Inhalation; Adrenal Cortex Hormones; Adult; Asthma; Female; Heroin; Humans; Pulmonary Eosinophilia; Substance-Related Disorders

Topics: Asthma; Drug Hypersensitivity; Heroin; Humans; Immunoglobulin E; India; Male; Middle Aged; Urticaria

Topics: Adult; Asthma; Heroin; Humans; Male; Occupational Diseases

Opiate addiction is an increasing social problem, and there has been a change from taking opiates intravenously to inhaling them in many areas of Britain. Three patients with asthma who required mechanical ventilation soon after heroin inhalation were described. Two subsequently died of acute severe asthma. The patients were reluctant to admit to their addiction and persisted inhaling heroin despite medical advice and counselling. Opiate inhalation can provoke life threatening asthmatic attacks and should be considered in patients at risk of abusing drugs who have poorly controlled asthma.

Topics: Administration, Inhalation; Adolescent; Adult; Asthma; Female; Heroin; Heroin Dependence; Humans; Male

Drug-induced lung diseases may present themselves as bronchial reactions (e.g. bronchial asthma), diseases of the parenchyma (e.g. pulmonary infiltrates with eosinophilia, diffuse fibrosing alveolitis), of the pulmonary vasculature (vasculitis) and of the pleura (e.g. pleurisy or pleural fibrosis). Pathogenetically the two most pertinent types of reaction are hypersensitivity or toxic reactions, and less often biologic reactions such as opportunistic infections after cytotoxic and immunosuppressive therapy. Many drug-induced respiratory diseases are reversible upon withdrawal of the offending agent; others may be irreversible or even progress.

Topics: Aspirin; Asthma; Bronchitis; Busulfan; Contraceptives, Oral, Hormonal; Dose-Response Relationship, Drug; Drug Hypersensitivity; Drug Interactions; Drug Tolerance; Heroin; Humans; Iodides; Lung Diseases; Methysergide; Pituitary Hormones, Posterior; Pleural Diseases; Polyarteritis Nodosa; Pulmonary Edema; Pulmonary Embolism; Pulmonary Eosinophilia; Trypsin