Crack cocaine (free base, alkaloid) provides a potent "high" when smoked but at a cost of serious complications. Frequent crack users will develop one or more pulmonary complications, some of which may be life-threatening.


Pulmonary changes seen after the smoking of crack cocaine:

(1) thermal injury to the bronchial tree

(2) inhalation of smoke debris

(3) exacerbation of asthma

(4) sarcoid-like noncaseating granulomas

(5) alveolar hemorrhage with hemoptysis

(6) pulmonary vascular disease with infarction

(7) pneumothorax and/or pneumomediastinum and/or pneumopericardium (barotrauma)

(8) bronciolitis obliterans with organizing pneumonia

(9) hypersensitivity pneumonitis

(10) non-cardiogenic pulmonary edema

(11) eosinophilic lung disease

(12) interstitial pneumonitis

(13) persistent abnormalities in gas exchange and pulmonary function

(14) acute lung injury


Risk factors for pulmonary complications:

(1) impure preparation

(2) pre-existing asthma

(3) pre-existing or concurrent lung disease

(4) heavy use of crack cocaine

(5) smoking other drugs of abuse

(6) cigarette smoking


Clinical features of "crack lung" syndrome:

(1) cough

(2) absent or low grade fever

(3) dyspnea

(4) hypoxemia

(5) pulmonary infiltrate on chest X-ray

(6) clinical improvement after corticosteroid therapy


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