title: Bronchial hyperreactivity in patients who inhale heroin mixed with cocaine vaporized on aluminum foil.
abstract: BACKGROUND
  In our area, inhaling heroin mixed with cocaine vaporized on aluminum foil, known as rebujo, is becoming more and more common.
  
  
  OBJECTIVE
  To define the prevalence and the characteristics of bronchial disease (wheezing, bronchial hyperreactivity [BHR], and asthma) present in subjects inhaling heroin mixed with cocaine vaporized on aluminum foil.
  
  
  METHODS
  Ninety-one subjects who inhaled the drug mixture were included in the study: 62 subjects were from a drug rehabilitation center (INH-I group), and 29 subjects were among patients admitted to our hospital for a variety of reasons (INH-II group). A questionnaire was completed in both groups, as well as IgE determination and lung function tests (spirometry and methacholine challenge). The control group consisted of 122 individuals who did not inhale the drug mixture, and were chosen randomly from the general population (NO-INH group). All subjects were tobacco smokers.
  
  
  RESULTS
  In the INH-I group, there was a 41.9% prevalence of wheezing over the past 12 months, a 44.4% prevalence of BHR, and a 22.02% prevalence of asthma, defined as wheezing plus BHR. In the NO-INH group, these values were 32.78% (p = 0.22), 15.57% (p < 0.0001), and 8.19% (p < 0.01), respectively. Of the subjects who inhaled the drug mixture and denied having symptoms prior to the use of the drug mixture, 31.4% had wheezing develop after commencing use of the drug, following a mean latency of 4.09 months. Wheezing remitted in only 7.6% after discontinuation of the drug.
  
  
  CONCLUSIONS
  (1) There is a real increase in BHR in subjects who inhale heroin mixed with cocaine vaporized on aluminum foil; and (2) this BHR is associated with wheezing that develops after a variable period of latency, once drug inhalation begins, and persists despite discontinuation of the drug.
authors.affiliation: Sección de Respiratorio, Hospital Juan Ramón Jiménez, Huelva, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Boto de los Bueis
authors.forename: Antonio
authors.initials: A
authors.lastname: Pereira Vega
authors.forename: José Luis
authors.initials: JL
authors.lastname: Sánchez Ramos
authors.forename: José Antonio
authors.initials: JA
authors.lastname: Maldonado Pérez
authors.forename: Rut
authors.initials: R
authors.lastname: Ayerbe García
authors.forename: Domingo
authors.initials: D
authors.lastname: García Jiménez
authors.forename: Emilio
authors.initials: E
authors.lastname: Pujol de la Llave
mesh_terms: D000280:Administration, Inhalation; D000328:Adult; D016535:Bronchial Hyperreactivity / Q000139:chemically induced* / Q000503:physiopathology; D001985:Bronchial Provocation Tests; D003042:Cocaine / Q000008:administration & dosage / Q000009:adverse effects*; D019970:Cocaine-Related Disorders / Q000503:physiopathology / Q000534:rehabilitation; D004347:Drug Interactions; D005260:Female; D003932:Heroin / Q000008:administration & dosage / Q000009:adverse effects*; D006556:Heroin Dependence / Q000503:physiopathology / Q000534:rehabilitation; D006801:Humans; D008297:Male; D016210:Methacholine Chloride; D012135:Respiratory Sounds / Q000503:physiopathology; D013030:Spain
chemical_list: D016210:Methacholine Chloride; D003932:Heroin; D003042:Cocaine