Inhaled heroin causing a life-threatening asthma exacerbation and marked peripheral eosinophilia

Abstract

Miss H was born in 1982 and diagnosed with asthma at the age of 7 years. In 2004 she presented with cough and wheeze, a peak flow of 55% predicted, an eosinophil count of 3.75 × 109/litre (normal range 0−0.4 × 109/litre) and a normal chest radiograph. In the preceding year, she attended the accident and emergency department twice and required six courses of prednisolone, despite taking low-dose inhaled steroids on a regular basis. A smoker, she lived in a rented room and was not registered with a doctor. Following standard treatment, she was prescribed an inhaled corticosteroid and long-acting β2-agonist. She took discharge against medical advice and failed to attend follow-up clinic. Two months later she was admitted with increasing wheeze and breathlessness, but refused investigations. During this admission, but only after direct questioning, she admitted to smoking heroin. She was discharged with community drug liaison service follow-up and abstained from heroin until she attended clinic 6 weeks later. At this point she had no symptoms and a supranormal peak flow. In February 2005, she become wheezy after inhaling heroin and was admitted overnight. She took her own discharge before seeing the hospital drug liaison team and again refused investigation. Admissions followed in June, July and August 2005, with life-threatening features on the last occasion, when she narrowly avoided ventilation. During this admission she recognized that exacerbations always followed heroin inhalation and she was referred to a direct access clinic to commence oral buprenorphine (Subutex, Schering-Plough, NJ, USA), a partial opioid antagonist.

Evaluation of Immunomodulatory and Hematologic Cell Outcome in Heroin/Opioid Addicts

“…The immune system is important for opioid users because the individuals with heroin use are in a high-risk group for the development of infectious diseases such as HIV and Hepatitis B and C as much as this addiction itself is a chronic disease causing numerous complications including alterations in immune responses [9, 10]. These functional alterations caused by opioids in immune cell functions have been investigated since the 1970s [11].…”

Evaluation of the respiratory system of non-alcohol drug addicted patients

“…Especially the common view that substance abuse by inhalation was less harmful than the IV mode among substance abusers has recently led to an increase in substance abuse through inhalation [11,12]. The results of our study showed that both heroin and cocaine were most commonly abused through inhalation and the rate of this mode of abuse was significantly higher than that of the IV mode.…”

Asthme et usage d’héroïne

“…Irritation et inflammation non spécifique des voies aériennes L'irritation et l'inflammation non spécifique des voies aériennes liées à la consommation d'héroïne provoquent une HRB, une bronchoconstriction et une majoration de l'inflammation bronchique préexistante. Plusieurs facteurs peuvent être en cause : agression thermique des voies aériennes par les vapeurs dégagées lors de la combustion, irritation de la muqueuse bronchique par les impuretés et/ou les agents de coupe de la poudre d'héroïne [4,5,37,65].…”