Crack lung, also known as crack lung syndrome, is a term doctors sometimes use to describe a collection of lung-related symptoms that frequently appear in people who use “crack” cocaine. This type of cocaine is directly inhaled into the lungs, where it can trigger inflammation, as well as a number of other problems that stem directly from this inflammation. People with crack lung develop symptoms that strongly resemble those associated with the presence of pneumonia. In addition, some affected individuals actually do develop a severe, potentially life-threatening form of pneumonia as a consequence of a crack lung’s effects.
The lungs are the body’s center for oxygen exchange, as well as the removal of a waste gas called carbon dioxide. Both of these processes take place in hundreds of millions of tiny sacs known as alveoli, which sit at the end of branching passageways that extend from the bottom of the windpipe (trachea) throughout the lungs’ tissues. The alveoli have permeable walls, and oxygen that enters from the lungs’ passageways exits through these walls and passes into the bloodstream through a network of super-thin blood vessels called capillaries. Oxygen-rich blood in these capillaries is then transported to the heart and distributed to the body through blood vessels called arteries. Oxygen-depleted blood, which contains abundant amounts of carbon dioxide waste, flows from the heart to the capillary network surrounding the alveoli. In this network, carbon dioxide gets sent outward through the alveoli and new supplies of oxygen flow into the bloodstream.
Crack Cocaine Basics
Crack cocaine is a rock- or nugget-like substance made by dissolving powdered cocaine (also known as cocaine hydrochloride) into water that contains sodium bicarbonate (baking soda). This form of the drug gets its name because it makes a cracking or popping sound when subjected to heat during the smoking process. People typically use crack because it’s cheaper than powdered cocaine and also produces a rapid onset of the euphoric feelings classically associated with all forms of cocaine use. The “high” that comes from a single instance of crack smoking lasts only for a few minutes; for this reason, people who smoke the drug commonly take multiple “hits” over the course of a drug-taking session in an effort to extend their euphoric experience. Over time, this repeated use leaves the lungs chronically exposed to crack’s damaging effects.
The main source of crack lung is ongoing inflammation caused by direct, chronic exposure to cocaine, as well as carbon and other byproducts, additives or contaminants contained in crack smoke, according to a comprehensive review of cocaine’s lung effects published in RadioGraphics, the Radiological Society of North America’s journal of record. This inflammation appears in all areas of the lungs and affects the alveoli, as well as the lung spaces in between the alveoli, known collectively as the interstitium. Forms of damage associated with crack lung-related inflammation include direct injury to the alveoli, hemorrhaging in the capillary network connected to the alveoli, and abnormal accumulation of a lung fluid called pleural fluid.
As stated previously, people afflicted with crack lung commonly develop symptoms that resemble the symptoms of pneumonia, including coughing, high fever, significant breathing difficulties and moderate to severe chest pain. In some cases, hemorrhaging of capillaries in the lungs leads to coughing that produces black or bloody sputum. In its extreme forms, crack lung can damage the lungs enough to trigger respiratory failure, a condition that occurs when not enough oxygen makes it from the alveoli to the bloodstream, or when not enough carbon dioxide makes it from the bloodstream to the alveoli. Potential consequences of this condition include organ damage and death.
The inflammation associated with crack lung comes from a condition called pulmonary eosinophilia, which gets its name from white blood cells called eosinophils, which belong to the immune system. When crack smoke enters the lungs, eosinophils start to gather as a protective mechanism; unfortunately the presence of too many eosinophils in one location triggers potentially damaging inflammation in the affected tissue. In rare cases, the presence of pulmonary eosinophilia leads to the development of acute idiopathic eosinophilic pneumonia, a severe condition that can produce the rapid onset of respiratory failure.
In addition to the direct lung injuries associated with crack lung, hemorrhaging in the lungs’ capillaries may be the result of cocaine-related changes inside the sympathetic nervous system, an involuntary system that helps maintain normal blood vessel health. Under cocaine’s influence, this system can produce capillary bleeding by creating blood pressure fluctuations that damage the capillary interiors.