The Drug-Induced Respiratory Disease Website and App

Abused drugs/substances (illicit-, street drugs - IV/inhaled)

Illicit or 'street' drugs, substances, chemicals and synthetic compounds whether inhaled or i.v. (IVDU) can produce a vast array of respiratory manifestations and complications, that can be life-threatening or fatal (PMID 24144776). These encompass bacterial infections which can involve the lung, pleura, chest wall and heart (PMID 16267325). Links to street names, nicknames of drugs and slang to facilitate history taking are included in a 'News' on right called 'Glossary of drug-related slang/street language'. See also under cocaine, heroin, methamphetamine, opiates, narcotics, vehicle, solvents, talc, starch, cellulose and mercury, alc and/or silica may also be an issue. For imaging, see PMID 8416551, 12376606, 17527131, 23168064, 24144776. The homeless is particularly at risk (PMID 30324539). The 'World Drug Report' provides updated data on the prevalent use and consumption of abused drugs. See also under body-packing/packers. See also under 'talc retinopathy'.

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.k

Exogenous lipoid pneumonia (subacute, acute)

I.n

ILD with a granulomatous component

I.t

A mass or masses

I.u

Pneumoconiosis (silicosis, talcosis...)

II - Pulmonary edema - Acute lung injury - ARDS

II.a

Pulmonary edema, noncardiogenic (NCPE)

II.e

ARDS - Acute lung injury

III - Pulmonary/alveolar./airway hemorrhage/bleeding

III.a

Alveolar hemorrhage (AH), diffuse AH (DAH)

IV - Airway involvement

IV.a

Bronchospasm - Wheezing - Asthma

IV.b

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

IV.ae

Cough syncope

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

V.c

Upper airway obstruction other than angioedema or hematoma

V.i

Thermal (burns, frostbite), chemical or caustic injury on the face, mouth, tongue, pharynx or upper airway

V.aj

Nasal, palatal and/or pharyngeal pathology

VI - Pleural and/or pericardial involvement

VI.f

Pneumothorax

VI.r

Empyema

VI.ac

Pneumothorax, bilateral

VII - Pulmonary vasculopathy

VII.b

Pulmonary arterial hypertension

VII.c

Pulmonary veno-occlusive disease

VII.g

Foreign body pulmonary vasculopathy (Excipient lung disease)

VII.i

Acute pulmonary hypertension

VII.j

Mercury pulmonary embolism

VII.q

Septic pulmonary embolism

VII.r

Pulmonary artery aneurysm(s)

VIII - Mediastinal involvement

VIII.h

Pneumomediastinum

VIII.i

Mediastinitis

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

IX.a

Diaphragm/inspiratory muscle weakness/paralysis (w/wo ARF)

IX.s

Botulism (foodborne-, wound-)

IX.ah

Acute myelopathy (can cause ARF)

X - Systemic/Distant conditions, syndromes and reactions

X.o

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

X.w

Multiple organ dysfunction/failure (MODS/MOF)

X.ae

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

X.bc

Foreign body (talc, cornstarch) retinopathy

XI - Miscellaneous

XI.b

Chest pain (acute or subacute), lone or prominent

XI.h

Aspiration, aspiration pneumonia (w/wo demonstrable pharyngeal dysmotility)

XI.k

Pulmonary emphysema - Lung cysts or bullae

XI.o

Death following exposure or poisoning

XII - Cardiovascular involvement / toxicity

XII.h

Coronary artery disease (acute) - Myocardial ischemia/infarction

XII.j

Endocarditis (infective)

XII.x

Hypertrophic cardiomyopathy

XVI - Imaging

XVI.d

Imaging: Alveolar opacities or haze with a batwing or butterfly distribution

XVI.u

Imaging: A miliary pattern (diffuse random micronodules)

XVI.v

Imaging: Centrilobular micronodules (can be diffuse)

XVI.ac

Imaging: Cavitating/cavitary lung nodule, mass or nodules (see also Iq, XIs, XIIi, XVIaa and XVIIp)

XVI.ad

Imaging: Lung cysts or bullae (see also XVI ah/bf)

XVI.ag

Imaging: A pattern similar to pneumoconiotic progressive massive fibrosis (PMF)

XVI.ak

Imaging: A 'tree-in-bud' pattern

XVII - Distinctive patterns - 'Eye-catchers'

XVII.t

Eye catcher: Purpuric/Ecchymotic/Cyanotic lesions of the earlobes and/or nose

XVII.u

Eye catcher: Talc retinopathy

XVII.x

Eye catcher: A batwing pattern on imaging

XIX - Pathology

XIX.j

Path: Micronodular organizing pneumonia/BOOP

XIX.ab

Path: Foreign body deposits/granulomatous reaction

XIX.ac

Path: Pneumoconiosis (silicosis, talcosis, talcoma)

XIX.an

Path: Foreign body embolism, microangiopathy, vasculopathy

XIX.ax

Path: Pulmonary hypertension incl. angiomatoid vasculopathy

XX - Infections & related conditions

XX.a

Respiratory tract infection incl. pneumonia

XX.b

Opportunistic pulmonary/systemic infections

XX.g

Tuberculosis (pulmonary, pulmonary, extrapulmonary or disseminated). Reactivation or de novo

XX.p

Lung abscess/abscesses (see also VIr)

XX.s

Sternoclavicular septic arthritis

XX.t

Epidural abscess

XX.ak

Osteomyelitis (notably of thoracic bones)