Dyspnea in a person who abuses drugs or alcohol needs to be investigated. It may be reversible or progressive, treatable or untreatable, significant or not.
The initial workup of the patient should include:
(1) a careful history of what has been abused
(2) identify how each substance was misused (smoked, intravenous injection, etc) and for how long
(3) concurrent high risk behaviors
(4) concurrent health issues
(5) baseline pulmonary function testing
(6) imaging studies
The differential diagnosis includes complications from
(1) smoking tobacco
(2) smoking marijuana
(3) smoking heroin or cocaine
(4) bacterial endocarditis
(5) cardiomyopathy
(6) pulmonary edema secondary to drug effect
(7) HIV-related infection
(8) tuberculosis or other pulmonary infection
(9) interstitial lung disease from allergens or toxins in the drugs
(10) aspiration
(11) microemboli to the lungs from injected materials
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