Does detoxification reverse the acute lung injury of crack smokers?
The effect on chronic crack users of a 3 month detoxification programme on lung clearance of inhaled 99Tcm-diethylenetriamine pentaacetate (99Tcm-DTPA) aerosol, spirometry and gas exchange was determined in a controlled in-patient clinical treatment setting. Imaging studies were carried out in eight chronic crack users (four crack-only and four crack plus tobacco) before and after the successful completion of the detoxification programme to measure the clearance of inhaled 99Tcm-DTPA from the lungs, an index of lung epithelial permeability. 99Tcm-DTPA lung clearance, expressed in terms of the biological half-time, T1/2, was determined from the slopes of the least-squares fit regression lines of the respective time-activity plots. The mean (+/- S.D.) global T1/2 values of the crack-only (75 +/- 39 min) and crack plus tobacco users (22 +/- 10 min) were significantly shorter (P < 0.02 and P < 0.001, respectively) than from the lungs of the non-smoking controls (124 +/- 29 min). This was consistent with increased lung epithelial permeability secondary to crack-related lung injury. The mean global T1/2 value of the crack plus tobacco users was significantly shorter (P < 0.05) than that of the crack-only users. After detoxification, the abnormally rapid lung clearance became normal in two of the four crack-only users studied, improved in a third and remained unchanged in the fourth, a subject whose T1/2 value was already normal initially. However, lung clearance improved in only one of the four crack plus tobacco users studied. Faster 99Tcm-DTPA clearance was the only impairment found in seven of the eight crack users, the eighth having restrictive lung disease. Crack-related lung injury, reflected by abnormally rapid 99Tcm-DTPA lung clearance, may be at least partially reversible after a 3 month period of abstinence from crack.
Susskind
H
H
Clinical Research Center, Brookhaven National Laboratory, Upton, NY 11973-5000, USA.
Weber
D A
DA
Atkins
H L
HL
Franceschi
D
D
Volkow
N D
ND
D000328:Adult; D002245:Carbon Dioxide / Q000097:blood; D016578:Crack Cocaine; D005541:Forced Expiratory Volume; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D008657:Metabolic Clearance Rate; D009293:Opioid-Related Disorders / Q000150:complications / Q000534:rehabilitation*; D010100:Oxygen / Q000097:blood; D011877:Radionuclide Imaging; D012907:Smoking; D013147:Spirometry / Q000379:methods; D016284:Technetium Tc 99m Pentetate / Q000493:pharmacokinetics; D013997:Time Factors; D014029:Tobacco Use Disorder / Q000150:complications / Q000534:rehabilitation*; D014797:Vital Capacity
D016578:Crack Cocaine; D002245:Carbon Dioxide; D010100:Oxygen; D016284:Technetium Tc 99m Pentetate