Crack Cocaine and Alveolar Hemorrhage

Crack Cocaine and Alveolar Hemorrhage

Alveolar hemorrhage is the medical term for bleeding in the blood vessels associated with the alveoli, tiny sacs within the lungs that pass oxygen into the bloodstream. Each lung contains hundreds of millions of these sacs, which play an absolutely essential role in human health. An alveolar hemorrhage can range in severity from non-significant to life-threatening. People who smoke “crack” cocaine have elevated risks for the onset of this condition; while some users of this drug have no outward symptoms of a lung hemorrhage, others quickly or gradually develop life-threatening degrees of lung damage.

Alveolar Hemorrhage Basics

When you breathe air into your lungs, its oxygen content passes through a series of progressively smaller passageways until it reaches the roughly 300 million alveoli (singular, alveolus) contained in each lung’s tissues. Each of these tiny sacs has a permeable wall, and is connected to a surrounding network of extremely small blood vessels called capillaries. When oxygen enters the alveoli, it passes steadily through the alveolar walls and into these blood vessels. Once inside the bloodstream, this oxygen gets transported to the heart and pumped to the body, where it fulfills its role in the baseline maintenance of life. Without the oxygen supplied through the alveoli, human beings would literally not be able to survive.

An alveolar hemorrhage, known more formally as a diffuse alveolar hemorrhage, occurs when something damages the capillaries associated with the lung’s alveoli and triggers bleeding inside the lung tissues. In addition to drug use, potential causes of this type of hemorrhage include the advancing effects of HIV infection, the autoimmune disorder lupus, a heart condition called mitral stenosis, complications of a bone marrow transplant, a blood vessel disorder called Wegener granulomatosis, and a rare kidney and lung disorder called Goodpasture syndrome. While relatively minor forms of alveolar hemorrhage may not produce any clear symptoms, potential consequences of the condition include coughing that produces bloody sputum, the red blood cell disorder called anemia, and respiratory failure that stems from an insufficient flow of oxygen into the bloodstream.

Cocaine’s Effects

Cocaine has a powerful ability to alter normal function in the body’s blood vessels and trigger an abnormal narrowing in those vessels known as vasoconstriction. This ability stems from the drug’s effects on a segment of the nervous system called the sympathetic nervous system, which normally plays a primary role in keeping the blood vessels and a variety of other organs in the body functioning within life-supporting limits. By encouraging an unusual buildup of a neurotransmitting chemical called norepinephrine, cocaine overexcites the sympathetic nervous system and, in addition to vasoconstriction, produces a number of other changes that degrade cardiovascular (heart and blood vessel) health. All forms of cocaine use trigger these changes; however, due to its direct effect on the lungs, crack cocaine use plays a particularly prominent role in the onset of diffuse alveolar hemorrhage.

Researchers believe that crack cocaine use triggers an alveolar hemorrhage in one of two ways, according to a well-regarded reference text called the Drug Abuse Handbook. In some cases, vasoconstriction related to inhalation of the drug apparently narrows the lungs’ capillaries so much that they sustain damage and start to leak their blood content into the surrounding tissue. In other cases, the passage of cocaine through the alveoli and into the bloodstream apparently directly damages the capillaries and makes them burst open. To a certain extent, the specific cause of an alveolar hemorrhage in most living cocaine users is speculative, since doctors can only fully examine the lungs of people who die or undergo lung surgery.


Coughing that produces bloody sputum is a prominent sign of alveolar hemorrhage in people who smoke crack, and anywhere from 6 to 26 percent of all crack users display this symptom, according to a study review of cocaine’s lung effects published in 2007 in the Radiological Society of North America journal RadioGraphics. In a significant number of cases, production of bloody sputum indicates the presence of large-scale bleeding inside the lungs that can kill an affected individual unless corrective surgery is performed. Some crack users develop a rapidly advancing form of hemorrhage that requires a prompt medical response, while others develop a serious hemorrhage slowly over time. Fully 70 percent of all crack smokers who die show at least some degree of alveolar hemorrhaging in their lung tissues.

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