Acute and Chronic Respiratory Symptoms among Primary Care Patients Who Smoke Crack Cocaine

Abstract

Among inner-city populations in Canada, the use of crack cocaine by inhalation is prevalent. Crack smoking is associated with acute respiratory symptoms and complications, but less is known about chronic respiratory problems related to crack smoking. There is also a gap in the literature addressing the management of respiratory disease in primary health care among people who smoke crack. The purpose of our study was to assess the prevalence of acute and chronic respiratory symptoms among patients who smoke crack and access primary care. We conducted a pilot study among 20 patients who currently smoke crack (used within the past 30 days) and who access the "drop-in clinic" at an inner-city primary health care center. Participants completed a 20- to 30-min interviewer-administered survey and provided consent for a chart review. We collected information on respiratory-related symptoms, diagnoses, tests, medications, and specialist visits. Data were analyzed using frequency tabulations in SPSS (version 19.0). In the survey, 95 % (19/20) of the participants reported having at least one respiratory symptom in the past week. Thirteen (13/19, 68.4 %) reported these symptoms as bothersome. Chart review indicated that 12/20 (60 %) had a diagnosis of either asthma or chronic obstructive pulmonary disease (COPD), and four participants (4/20, 20 %) had a diagnosis of both asthma and COPD. Majority of the participants had been prescribed an inhaled medication (survey 16/20, 80 %; chart 12/20, 60 %). We found that 100 % (20/20) of the participants currently smoked tobacco, and 16/20 (80 %) had smoked both tobacco and marijuana prior to smoking crack. Our study suggests that respiratory symptoms and diagnoses of asthma and COPD are prevalent among a group of patients attending an inner-city clinic in Toronto and who also smoke crack. The high prevalence of smoking tobacco and marijuana among our participants is a major confounder for attributing respiratory symptoms to crack smoking alone. This novel pilot study can inform future research evaluating the primary health care management of respiratory disease among crack smokers, with the aim of improving health and health care delivery.

Public opinions about supervised smoking facilities for crack cocaine and other stimulants

“…Although there are reports of decline in crack cocaine use in both Canada and the United States [ 39 , 40 ], its use remains a public health concern. However, as noted above, public health programming for people who smoke crack cocaine lags behind what is available for people who inject drugs despite evidence of serious, and sometimes fatal, harms associated with smoking these drugs [ 41 , 42 ]. To our knowledge, this is the first study to report public opinion about SSFs.…”

Gender differences in causes of death among persons with HIV/AIDS in San Francisco, California, 1996–2013

“…In addition to cigarette smoking, the elevated rate of COPD in our study population, particularly among women, may also be attributed to smoking crack cocaine. 76,77 Women, but not men had an elevated risk of death from cerebrovascular and heart disease compared to the general population, as has been found in a mortality study among people with HIV in a New York City HIV surveillance registry. 45 Many of the non-AIDS cancers may also be attributable to tobacco use.…”

Mucociliary dysfunction in HIV and smoked substance abuse

“…Cocaine abuse either by way of snorting crystalline cocaine or smoking crack cocaine results in the airway exposed to the highest concentration of this drug. Asthma and COPD are common among cocaine users (Rubin and Neugarten, 1990 ; Leece et al, 2013 ). Moreover, a single exposure to cocaine can lead to persistence of the drug in the airway hours after smoking (Byck and Van Dyke, 1977 ).…”