Which respiratory findings are characteristic of cocaine toxicity?

Updated: Dec 31, 2020
  • Author: Lynn Barkley Burnett, MD, EdD, JD; Chief Editor: Sage W Wiener, MD  more...
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The incidence of respiratory complaints in people who use cocaine is not known. The following respiratory toxic reactions are reported in association with cocaine use:

  • Barotrauma (eg, pneumothorax, pneumopericardium, pneumomediastinum)

  • Pulmonary hemorrhage or infarction

  • Diffuse alveolar hemorrhage

  • Pulmonary edema

  • Wheezing secondary to bronchial muscle constriction

  • Airway irritation via damage to bronchial epithelial cells, and stimulation of vagal receptors, inducing bronchospasm, exacerbating asthma

  • Eosinophilic lung disease

  • Recurrent transient pulmonary infiltrates with peripheral eosinophilia

  • Chronic diffuse interstitial pneumonia with mild fibrosis

  • CNS stimulant effects (eg, neurogenic pulmonary edema, respiratory depression in overdose or postictal state, abnormal hypoxic response in infants of cocaine-abusing mothers, sudden infant death syndrome (SIDS), and pulmonary hypertension)

  • Crack lung or transient pulmonary infiltrates

  • Nasal septum perforation and/or aspiration

  • Bronchiolitis obliterans organizing pneumonia

  • Granulomatosis

  • Sinusitis

  • Epiglottitis

  • Bronchitis

  • Cellulose granulomas in lung

  • Panlobular emphysema

  • Needle or other foreign body aspiration

  • Alveolar accumulation of carbonaceous material

  • Airway burns or tracheal stenosis

  • Tachypnea, irregular breathing

  • Respiratory arrest

  • Acute lung injury (noncardiogenic [increased permeability] pulmonary edema)

  • Torticollis, trismus, and laryngospasm may endanger the airway.

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