New‐onset Bronchospasm or Recrudescence of Asthma Associated with Cocaine Abuse

Abstract

Objective: To determine whether the occurrence of new-onset bronchospasm or the recrudescence of asthma is associated with the use of cocaine. Methods: A consecutive sample of patients presenting to an inner-city adult ED with new-onset bronchospasm or recrudescence of bronchospasm after >5 years were prospectively enrolled in a case-control prevalence study. The bronchospasm patients were queried as to their exposure to illicit drugs, and urine was obtained to screen for cocaine and its metabolite, benzoylecgonine. An age-and sex-matched control group was composed of randomly chosen subjects without respiratory complaints or a history of asthma. The control group was also screened by urine toxicology for cocaine and its metabolite, benzoylecgonine. Results: In the asthma group, 21/59 (36%) had a urine toxicologic screen positive for cocaine metabolite (benzoylecgonine). Of the 21 with a positive screen for cocaine, 8 denied illicit drug abuse. Among the 13 patients reporting drug use, 10 said that they smoked crack and 3 snorted cocaine. In the control group, 8/53 (15%) were positive. Multivariate logistic regression analysis, with adjustment for age and sex, indicated that the use of cocaine was associated with a 3-fold higher prevalence of new-onset bronchospasm or recrudescence of asthma (OR = 3.28, 95% CI: 1.26 to 8.50).Conclusions: There appears to be an association between cocaine use and new-onset bronchospasm or recrudescence of asthma in this inner-city ED population. Further study is necessary to determine the basis for this association. Key words: asthma; bronchospasm; allergy; cocaine; substance abuse. IThe epidemic use of cocaine, especially in the smoked freebase form ("crack"), has paralleled the increasing incidence of asthma. In our inner-city ED, we noticed a high incidence of cocaine abuse among patients with new-onset bronchospasm. Isolated case reports,'-' small case series,6-8 an unpublished prospective study,g and a prospective, case-control study using a convenience sample of asthmatic patients" have described the coincidence of cocaine abuse and pulmonary complications. However, few of the patients described had bronchospasm, and The current study addresses the potential association of asthma with cocaine use in adult patients with newonset bronchospasm or the recrudescence of asthma after a prolonged period of quiescent disease. I METHODSStudy Design: We performed a prospective, case-control, cross-sectional, prevalence study to determine whether an association existed between cocaine use and new-onset bronchospasm or recrudescence of asthma in an inner-city ED population. The project was approved by the local institutional review board (IRB). The IRB ruled that since urine toxicology testing for new-onset bronchospasm or recrudescent asthma was routinely performed in our ED, and since the testing in the control group was anonymous, informed consent was not necessary. Population and Setting:T h e study was performed in an inner-city teaching hospital ED with a census of approximately...

“Dangerous Relationships”: Asthma and Substance Abuse

“…Several studies have shown that patients who abuse drugs may be at increased risk of severe asthma exacerbations or asthma death. 14,15,19,20,48 Baxter et al 72 demonstrated that patients with substance-related disorders and persistent asthma fill prescriptions for controller medications at lower rates than patients without substance-related disorders. Although the authors cannot say whether these differences are due to differential access to care, decreased compliance with treatment recommendations, or the receipt of substandard care, these findings still may partially explain the disparities in asthma outcomes observed for these patients.…”

“…Several studies reported a relatively high prevalence of cocaine use among patients with asthma exacerbation that possibly contributes to the increase in asthma morbidity. 15,16,19 Levine et al 16 reported a 42.8% prevalence rate of cocaine or heroin use among adult patients who had been admitted to an inner-city Chicago hospital for acute asthma exacerbations. They also found that cocaine use was associated with higher intubation rates and with longer lengths of stay and a higher likelihood of being admitted to the intensive care unit.…”

“…In another study, patients in the emergency department who reported newonset bronchospasm were tested for cocaine metabolites, with 21 (36%)of 59 patients having positive results. 15 This was compared with a control group of randomly selected, age-and sex-matched individuals without a history of respiratory disease, in which 15% tested positive for cocaine. 15 This finding indicates an association between cocaine use and new-onset bronchospasm or recrudescence of asthma.…”

“…15 This was compared with a control group of randomly selected, age-and sex-matched individuals without a history of respiratory disease, in which 15% tested positive for cocaine. 15 This finding indicates an association between cocaine use and new-onset bronchospasm or recrudescence of asthma. In a similar study by Gaeta and Hammock, 16 44 of 100 (44%) patients with asthma admitted to or tested positive for illicit drugs, compared with 20 of 100 (20%) control patients.…”

Prevalence of common chronic respiratory diseases in drug misusers: a cohort study

“…This observation has also been supported by anecdotal evidence from clinical colleagues, although there is little published research in this area. 6 Previous studies have reported an association between drug misuse and asthma exacerbations [7][8][9][10] and respiratory disease and lower quality of asthma care among drug misusers. 11 Other previous studies also suggest a possible association between asthma mortality and drug misuse.…”