NIDA Conference Report on Cardiopulmonary Complications of “Crack” Cocaine Use

Thadani, Pushpa V.

doi:10.1378/chest.110.4.1072

Cited by 36 publications

(23 citation statements)

References 28 publications

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“…Understanding the health effects of these drugs is therefore more important than ever. While marijuana is known to produce chronic bronchitis and a cellular alveolitis in chronic users (4,5), and cocaine can induce "crack lung" in cases of extreme abuse (6), relatively little is known about the effects of these inhaled drugs on pulmonary host defenses.…”

mentioning

confidence: 99%

Marijuana and Cocaine Impair Alveolar Macrophage Function and Cytokine Production

Baldwin

Tashkin

Buckley

et al. 1997

Am J Respir Crit Care Med

219

140

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Use of marijuana and cocaine is on the rise in the United States. Although pulmonary toxicity from these drugs has occasionally been reported, little is known about their effects on the lung microenvironment. We evaluated the function of alveolar macrophages (AMs) recovered from the lungs of nonsmokers and habitual smokers of either tobacco, marijuana, or crack cocaine. AMs recovered from marijuana smokers were deficient in their ability to phagocytose Staphylococcus aureus (p < 0.01). AMs from marijuana smokers and from cocaine users were also severely limited in their ability to kill both bacteria and tumor cells (p < 0.01). Studies using NG-monomethyl-L-arginine monoacetate, an inhibitor of nitric oxide synthase, suggest that AMs from nonsmokers and tobacco smokers were able to use nitric oxide as an antibacterial effector molecule, while AMs from smokers of marijuana and cocaine were not. Finally, AMs from marijuana smokers, but not from smokers of tobacco or cocaine, produced less than normal amounts of tumor necrosis factor-alpha, granulocyte-macrophage colony-stimulating factor, and interleukin-6 when stimulated in culture with lipopolysaccharide. In contrast, the production of transforming growth factor-beta, an immunosuppressive cytokine, was similar in all groups. These findings indicate that habitual exposure of the lung to either marijuana or cocaine impairs the function and/or cytokine production of AMs. The ultimate outcome of these effects may be an enhanced susceptibility to infectious disease, cancer, and AIDS.

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confidence: 99%

Marijuana and Cocaine Impair Alveolar Macrophage Function and Cytokine Production

Baldwin

Tashkin

Buckley

et al. 1997

Am J Respir Crit Care Med

219

140

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“…Cardiovascular events associated with crack cocaine include myocardial infarction, myocarditis, dilated cardiomyopathy, heart failure, coronary and peripheral vascular spasm, dysrhythmia, and sudden cardiac death 8.…”

Section: Discussionmentioning

confidence: 99%

“Crack Lung and Heart” Presenting after Chemotherapy in a 65-Year-Old Man with Non-Hodgkin Lymphoma

Alvarez

Jagt

2008

Current Oncology

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Crack cocaine can cause a variety of pulmonary and cardiac complications. Pulmonary findings in a 65-year-old man with non-Hodgkin lymphoma who presented with shortness of breath not resolving with antibiotics are presented here. The usual manifestation of "crack lung" in an unusual clinical circumstance underlines the importance of a clinical history in such cases. The finding of "crack lung" preceded the diagnosis of probable "crack heart." No other similar published case reports could be identified in the literature. KEY WORDS"Crack lung," cocaine, non-Hodgkin lymphoma PRESENTATIONA 65-year-old man with biopsy-proven follicular nonHodgkin lymphoma grade 2 was referred for treatment. At initial presentation, he had shortness of breath on exertion and wheezing. Past medical history included idiopathic venous thrombosis in his right arm, hypertension, and chronic sinusitis. He was a 20-packper-year smoker and a known cocaine abuser. He was taking amoxicillin, fluticasone propionate nasal spray, coumadin, and thiazide. He had no known drug allergies, no travel history, and no sick contacts. His chest radiograph demonstrated interstitial opacifications, and an axial computed tomography (CT) image of the thorax (Figure 1) showed bibasilar "ground glass" opacification with septal thickening.This patient did not respond to a course of amoxicillin, and his shortness of breath began to worsen. Vital signs were normal. Physical exam demonstrated bilateral wheezing and extensive lymphadenopathy in the cervical, suboccipital, posterior cervical, anterior cervical, tonsillar, submental, supraclavicular, and femoral regions. The initial cardiac examination revealed normal heart sounds, with a normal jugular venous pressure, but with 2+ pitting edema bilaterally.The patient was referred to respirology consultation for investigation to rule out an opportunistic infection. He missed the appointment with the respirologist and returned 4 months later to the clinic. InvestigationsThe patient's complete blood count at the first visit was completely normal. In addition, electrolytes, liver enzymes, urea, and creatinine were all within normal limits. Serology for HIV was negative. Sputum initially showed heavy growth of normal respiratory flora. No acid-fast bacilli were seen in the sputum. Bronchoscopy washings were negative for Gram and fungal stains. An enhanced CT of the thorax in the lung window confirmed bibasilar "ground glass" opacifications with septal thickening. Significant mediastinal lymphadenopathy was noted. A cardiac nuclear scan performed at the time revealed normal left ventricular function with a normal contractile pattern. Course Between First and Second Thorax CTThe patient admitted to having a crack cocaine addiction. He had missed his first respirology

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“…C'est la potentialisation de la transmission dopaminergique dans le système mésocorticolimbique qui serait en partie responsable de la très forte dépendance psychique observée avec la cocaïne [1,14]. L'effet anesthésiant est obtenu par blocage des canaux sodium [30] Après la fin des effets euphorisants de la cocaïne, on observe une phase de descente avec inversion de l'humeur. La dépression succède à la stimulation, l'anxiété et l'irritabilité à la confiance en soi et à l'euphorie.…”

Section: Pharmacologieunclassified