Acute Effects of Inhaled and IV Cocaine on Airway Dynamics

¹ From the Department of Medicine, UCLA School of Medicine, Los Angeles
² From the Department of Medicine, and West Los Angeles Veterans Affairs Medical Center, Los Angeles
³ From the Department of Medicine, UCLA School of Medicine, and West Los Angeles Veterans Affairs Medical Center, Los Angeles

Background: Wheezing has been reported by 32% of habitual smokers of crack cocaine, and several cases of crack-related acute exacerbations of asthma have been reported.

Study objective: To compare the acute effects of physiologically active doses of smoked cocaine base and IV cocaine hydrochloride (HCl), a subphysiologic dose of cocaine base (smoked "placebo"), and IV saline solution placebo on bronchomotor tone, subjective level of intoxication, and cardiovascular responses in healthy habitual crack users.

Design: A single-blind crossover study in which the order of route of administration (inhaled vs IV) was random but placebo always preceded the active drug.

Subjects: Fourteen healthy, nonasthmatic current crack-smoking subjects, 34 to 48 years of age, with a history of previous IV cocaine use (1 to 12 times per lifetime).

Methods: Heart rate, BP, self-rated level of intoxication (scale of 0 to 10), and measurements of airway resistance (Raw) and specific airway conductance (SGaw) were recorded during separate sessions before and 3 to 5, 10, 15, and 30 min after administration of smoked cocaine base (38.5±2.3 [SEM] mg), smoked placebo (2.3±0.9 mg cocaine base), IV cocaine HCl (30.0±2.0 mg), and IV placebo (saline solution).

Results: Both smoked active cocaine and IV cocaine HCl caused comparable, significant (p<0.05) peak levels of acute intoxication (6.7±0.7 and 7.3±0.8, respectively) and increases in heart rate from baseline (29.6±2.9% and 21.4±3.7%, respectively, at 5 min). However, only smoked active cocaine caused significant decreases from baseline in SGaw (25.4±6.3% at 5 min), in contrast to nonsignificant changes after IV cocaine HCl (5.6±7.0% increase) and smoked placebo (10.2±6.0% decrease).

Conclusions: Smoked cocaine base, but not systemically administered cocaine HCl, causes acute bronchoconstriction that is probably mediated by local airway irritation and could account for reports of crack-induced wheezing and asthma attacks in nonasthmatic and asthmatic individuals, respectively.

Key Words: airway resistance • bronchomotor tone • cocaine base • cocaine HCl

Submitted on January 25, 1996
Accepted on April 9, 2007

This article has been cited by other articles:

				K. C. Wilson and J. J. Saukkonen Acute Respiratory Failure from Abused Substances J Intensive Care Med, July 1, 2004; 19(4): 183 - 193. [Abstract] [PDF]

				A. J. Krantz, R. C. Hershow, N. Prachand, D. M. Hayden, C. Franklin, and D. O. Hryhorczuk Heroin Insufflation as a Trigger for Patients With Life-Threatening Asthma Chest, February 1, 2003; 123(2): 510 - 517. [Abstract] [Full Text] [PDF]

				E. C. Kleerup, S. N. Koyal, J. A. Marques-Magallanes, M. D. Goldman, and D. P. Tashkin Chronic and Acute Effects of "Crack" Cocaine on Diffusing Capacity, Membrane Diffusion, and Pulmonary Capillary Blood Volume in the Lung* Chest, August 1, 2002; 122(2): 629 - 638. [Abstract] [Full Text] [PDF]

				D. Zaas, M. Brock, S. Yang, and J. T. Sylvester An Uncommon Mimic of an Acute Asthma Exacerbation* Chest, May 1, 2002; 121(5): 1707 - 1709. [Abstract] [Full Text] [PDF]

				A. Boto de los Bueis, A. Pereira Vega, J. L. Sanchez Ramos, J. A. Maldonado Perez, R. Ayerbe Garcia, D. Garcia Jimenez, and E. Pujol de La Llave Bronchial Hyperreactivity in Patients Who Inhale Heroin Mixed With Cocaine Vaporized on Aluminum Foil* Chest, April 1, 2002; 121(4): 1223 - 1230. [Abstract] [Full Text] [PDF]

				L. A. Rome, M. L. Lippmann, W. C. Dalsey, P. Taggart, and S. Pomerantz Prevalence of Cocaine Use and Its Impact on Asthma Exacerbation in an Urban Population Chest, May 1, 2000; 117(5): 1324 - 1329. [Abstract] [Full Text] [PDF]