Pulmonary disorders associated with use of illicit drugs

Illicit drug use is associated with the development of both acute and chronic pulmonary disorders. Some pulmonary diseases are induced by contaminants. An example is foreign-body granulomatosis of the lungs, which occurs in individuals who inject drugs containing foreign materials such as talc. The use of cocaine, and particularly inhaled crack cocaine, is associated with a high incidence of acute pulmonary symptoms including cough and chest pain. Various cocaine-mediated pulmonary disorders include alveolar hemorrhage, pulmonary edema, bronchiolitis obliterans and organizing pneumonia, pulmonary eosinophilia, and interstitial pneumonitis. Heroin, as well as other opiates, and the inhaled form of methamphetamine ("ice") can induce acute pulmonary edema in drug users. Severe emphysema has been reported to develop in young drug abusers who intravenously use the drug meththylphenidate. Marijuana users often develop symptoms of chronic bronchitis. Long-term users seem to be at increased risk for lung cancer and chronic obstructive pulmonary disease, although the relative risk compared with tobacco smokers is uncertain. The use of illicit drugs may exacerbate underlying asthma, and illicit drug use is associated with an increased risk of fatal asthma. The diagnosis of illicit drug-induced lung disease may be difficult if an accurate history of drug use is not obtained. Establishing the diagnosis of drug-induced lung disease is important because appropriate treatment may also require referral for drug counseling or rehabilitation.