Overview of pulmonary disease in injection drug users
- Jill P Karpel, MD
Jill P Karpel, MD
- Professor of Medicine
- Albert Einstein College of Medicine
Injection drug users (IDUs) are at increased risk for acute and chronic pulmonary complications. These sequelae may be due to pharmacodynamic properties of the drugs, effects of intravenous contaminants, or complications of the intravenous route of administration.
The general pulmonary complications and drug-specific pulmonary diseases that may result from injection drug use will be reviewed here. Other complications of injection drug use, such as foreign body granulomatosis, infective endocarditis, opioid use disorder, cocaine intoxication, and methamphetamine intoxication, are reviewed separately. (See "Substance use disorder: Principles for recognition and assessment in general medical care" and "Foreign body granulomatosis" and "Infective endocarditis in injection drug users" and "Pharmacotherapy for opioid use disorder" and "Acute opioid intoxication in adults" and "Cocaine: Acute intoxication" and "Methamphetamine intoxication".)
The pulmonary complications associated with intravenous injection of illicit drugs include pneumonia, septic embolization, noncardiogenic pulmonary edema, foreign body granulomatosis, emphysema, interstitial lung disease, pulmonary vascular disease, pneumothorax, and an increased incidence of fatal asthma [1-4].
Pneumonia — Injection drug users (IDUs) have a 10-fold increased risk of community-acquired pneumonia compared with the general population . This may be due to a number of factors:
●Concurrent smoking of cigarettes or illicit drugs may impair local lung defenses, macrophage activity, and mucociliary clearance
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- PULMONARY COMPLICATIONS
- Septic emboli
- Noncardiogenic pulmonary edema
- Foreign body granulomatosis
- Bullous lung disease and emphysema
- Interstitial lung disease
- Pulmonary hypertension
- Pneumothorax and pneumomediastinum
- DRUG-SPECIFIC COMPLICATIONS
- Methylphenidate and methamphetamine
- SUMMARY AND RECOMMENDATIONS