The Drug-Induced Respiratory Disease Website and App

Cocaine

Cocaine is mostly snorted. Review of cadiovascular complications: PMID 11484693. See also under crack cocaine and levamisole, as most cocaine samples are now laced with that adulterant (PMID 25544694, 30634141). Levamisole per se can cause ANCA-related vasculitis or DAH. Other cutting agents include phenacetin, caffeine, hydroxyzine and benzocaine. See PMIDs 9358986, 1731605, 17620460, 21980179, 23196334, 24429586, 29459175, 29782427, 30634141

Frequency - Incidence

Incidence of respiratory adverse event(s) due to the specific drug as assessed by number of reported/published cases in the literature. Red digits in stars indicate: 0 = Very rare, questionable signal · 1 = < 10 cases · 2 = 10-50 cases · 3 = 50–100 cases · 4 = 100-200 cases · 5 = >200 cases

Evidence level/grade

Evidence level for respiratory adverse event(s) due to the specific drug as estimated using Hill’s (1965), Naranjo’s (1981), and Bégaud’s (1985) criteria applied to published cases. Blue digits in stars indicate: 0 = Questionable · 1 = Low · 2 = Moderate · 3 = Robust · 4 = Definite · 5 = Unquestionable, pathognomonic

I - Interstitial/parenchymal lung disease

I.c

Eosinophilic pneumonia (pulmonary infiltrates and eosinophilia)

I.d

Acute eosinophilic pneumonia (AEP)

I.e

Organizing pneumonia pattern (an area or areas of consolidation on imaging)

I.u

Pneumoconiosis (silicosis, talcosis...)

I.aa

An area or areas of consolidation

XLI - Pulmonary edema - Acute lung injury - ARDS

XLI.a

Pulmonary edema, noncardiogenic (NCPE)

XLI.b

Pulmonary edema, cardiogenic

XLII - Pulmonary/alveolar./airway hemorrhage/bleeding

XLII.a

Alveolar hemorrhage (AH), diffuse AH (DAH)

XLII.b

Pneumorenal syndrome (w/wo ANCAs)

XLII.c

Hemoptysis

XLII.n

Alveolar hemorrhage (subclinical, or as a BAL feature)

XLIII - Airway involvement

XLIII.a

Bronchospasm - Wheezing - Asthma

XLIII.b

Severe or catastrophic bronchospasm or asthma attack (can be fatal)

XLIII.g

Airway hyperresponsiveness

XLIV - Central-large-upper airway (incl. pharyngeal-nasal) involvement

XLIV.a

Angioedema (may cause UAO, asphyxia and death)

XLIV.c

Upper airway obstruction other than angioedema or hematoma

XLIV.l

Midline destructive lesions

XLIV.p

Foreign body in the airway

XLIV.q

Drug foreign body in the airway

XLIV.w

Uvulitis, uvular edema

XLIV.ai

Tracheal polyps

XLIV.aj

Nasal, palatal and/or pharyngeal pathology

XLIV.al

Rhinitis medicamentosa

XLIV.aq

Airway foreign body

XLV - Pleural and/or pericardial involvement

XLV.f

Pneumothorax

XLV.ac

Pneumothorax, bilateral

XLVI - Pulmonary vasculopathy

XLVI.a

Pulmonary embolism - Venous thrombosis/thromboembolism

XLVI.b

Pulmonary arterial hypertension

XLVI.l

Acute pulmonary vasoconstriction and PHT

XLVII - Mediastinal involvement

XLVII.h

Pneumomediastinum

XLVIII - Neuromuscular / CNS involvement - Disordered breathing (during sleep)

XLVIII.k

Trismus (lockjaw)

XLVIII.o

Pneumorachis

XLIX - Systemic/Distant conditions, syndromes and reactions

XLIX.f

Anaphylaxis-Anaphylactoid reaction (can be fatal)

XLIX.j

Eosinophilic granulomatosis with polyangiitis (Churg-Strauss)

XLIX.l

Myopathy-Myositis-Polymyositis (see also under Xba)

XLIX.o

Vascultis (pulmonary, extrathoracic or systemic)-ANCA status unknown or negative)

XLIX.q

Neutrophilic dermatosis (Pyoderma, Sweet syndrome)

XLIX.u

Vasculitis, pulmonary (w/wo AH), extrapulmonary, systemic: ANCA-positive

XLIX.w

Multiple organ dysfunction/failure (MODS/MOF)

XLIX.z

ANCA positivity. Subclinical or with clinical manifestations

XLIX.ae

Anti-GBM antibody disease (Goodpasture-like or flare of preexisting GS)

XLIX.af

Skin purpura, ecchymoses or necrosis

XLIX.au

Scleroderma renal crisis

L - Miscellaneous

L.b

Chest pain (acute or subacute), lone or prominent

L.k

Pulmonary emphysema - Lung cysts or bullae

L.l

Neutropenia, agranulocytosis (w/wo infection/sepsis)

L.o

Death following exposure or poisoning

L.ab

Barotrauma (incl. pneumothorax, pneumomediastinum, interstitial ephysema...)

L.au

Sneezing (may cause pulmonary barotrauma)

LI - Cardiovascular involvement / toxicity

LI.a

Left or biventricular dysfunction/failure

LI.f

Takotsubo (stress) cardiomyopathy

LI.g

Cardiomyopathy (acute, subacute, chronic)

LI.h

Coronary artery disease (acute) - Myocardial ischemia/infarction

LI.n

Cardiac arrhythmias or dysrhythmias (AF, VT, VF, TdP)

LI.aa

Pneumopericardium

LI.ag

Aortic dissection

LI.ah

Coronary vasospasm - Vasospastic angina

LI.al

Systemic arterial thrombosis

LI.ar

Coronary artery dissection

LIII - Hemoglobinopathies - Abnormal hemoglobin states (acquired)

LIII.b

Carboxyhemoglobinemia

LV - Imaging

LV.k

Imaging: An area or areas of consolidation

LVIII - Pathology

LVIII.b

Path: Eosinophilic pneumonia (subacute or acute) (see also Ic)

LVIII.r

Path: Alveolar hemorrhage (see also IIIa)

LVIII.t

Path: Pulmonary edema (see also II/IIa)

LVIII.v

Path: NSIP-fibrotic pattern

LVIII.ac

Path: Pneumoconiosis (silicosis, talcosis, talcoma)

LVIII.cz

Path: Skin vasculopathy/vasculitis/fibrin thrombi

LIX - Infections & related conditions

LIX.b

Opportunistic pulmonary/systemic infections