25 Mar Cocaine and BOOP
A 30-year-old pregnant woman is brought to the emergency room because of difficulty breathing and agitation following the use of crack cocaine. About a week before hospital admission, she developed a dry cough and was short of breath. Labor was induced with the delivery of a normal infant, but after 48 days in the hospital, the new mother died. Doctors blamed a condition known as bronchiolitis obliterans with organizing pneumonia (BOOP) for her death and said crack cocaine was the cause of BOOP.
BOOP is a lung condition in which the small airways (bronchioles), the tiny air-exchange sacs (alveoli) and the walls of small bronchi become inflamed and plugged with connective tissue. While some people with BOOP have no serious symptoms, others experience a severe and potentially fatal complication called respiratory failure. People who inhale cocaine have elevated risks for bronchiolitis. Smokers of cocaine, in particular, can develop forms of BOOP that result in death.
Bronchioles are the narrowest form of passageways in the lungs. When you breathe in, air passes through the larger bronchi until it reaches the bronchioles. It then passes from the bronchioles to the alveoli, which transfer oxygen and other air components through their permeable walls and into tiny blood vessels called capillaries. The oxygen-bearing blood in these capillaries is then distributed through the heart to all areas of the body. In addition to their role in getting oxygen into the body, the bronchioles and alveoli play a vital role in removing carbon dioxide waste from the bloodstream. This waste gas passes from the lung capillaries through the walls of the alveoli and up through the bronchioles on its way out of the lungs.
BOOP gets its name because it produces a form of inflammation that obliterates bronchioles. Inflammation in the lungs is typically referred to as pneumonia, which most people associate with some sort of lung infection. But the term is actually more general and also applies to inflammation stemming from drug exposure.
In the case of bronchiolitis obliterans, pneumonia in the bronchioles and alveoli is associated with the onset of fibrosis, a condition that involves the abnormal overgrowth of connective tissue cells called fibroblasts. This fibroblast overgrowth results in scarring that destroys normal function in the affected bronchioles and alveoli. Common symptoms of lung fibrosis include an uncomfortable feeling in the chest, shortness of breath, a hacking cough that doesn’t produce phlegm or sputum, unexplained weakness and/or fatigue, and appetite loss combined with a rapid drop in weight.
The destruction of bronchioles and alveoli in people with BOOP can trigger respiratory failure. This condition arises when oxygen can’t pass efficiently from the lungs to the bloodstream, or when carbon dioxide can’t pass efficiently from the bloodstream to the lungs. Some people with respiratory failure develop only one of these problems, while others develop both simultaneously. Without its required supply of oxygen, the body can’t support the vital processes necessary to sustain life. Without the ability to properly eliminate carbon dioxide waste, the body will start to incur damage in its essential organs. Extreme forms of respiratory failure can kill, especially when they develop rapidly.
In people who use crack cocaine, BOOP can be viewed as a complication of “crack lung,” a condition that occurs when long-term inhalation of crack smoke repeatedly exposes lung tissue to the toxic effects of cocaine, as well as the damaging effects of carbon, silica and other harmful substances in crack smoke. In addition to impairing the bronchioles and alveoli, crack smoke damages the spaces that sit between clusters of alveoli known as the interstitium. Even young crack smokers who die of respiratory failure show clear signs of BOOP during autopsy.
People who inhale cocaine can develop a less severe form of BOOP, the authors of a study in the Radiological Society journal RadioGraphics explain. Typically, this version of the disorder manifests as fibrosis in the interstitium, formation of abnormal cells in the walls of the bronchioles, unusual thickening of the bronchioles, and an abnormal restriction in the ability to breathe. The relative lack of BOOP severity in these cases probably stems from a lower level of lung exposure to cocaine’s direct effects.
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