Heroin insufflation as a trigger for patients with life-threatening asthma.
OBJECTIVE
To determine the prevalence of self-reported, heroin-associated asthma symptoms among inner-city patients treated for life-threatening asthma, and to compare the rates of drug use between ICU patients with asthma and ICU control patients with diabetic ketoacidosis (DKA).


METHODS
Study 1 was a sequential case series of patients requiring ICU admission for asthma (January to June 1999). Study 2 was a retrospective, case-control study of drug use among asthma patients and control subjects with DKA requiring ICU care (1997 to 1998).


METHODS
Inner-city, public hospital ICU.


METHODS
Twenty-three patients (26 ICU admissions) with asthma (age range, 16 to 50 years) admitted to the ICU from January to June 1999, and 84 patients (104 ICU admissions) with asthma and 42 patients with DKA (age range, 15 to 50 years) admitted to the ICU during 1997 to 1998. Outcomes studied: Self-reported, heroin-associated exacerbations, history of heroin or cocaine use, and urine drug screen (UDS) results.


RESULTS
In the sequential ICU admissions, 13 of 23 patients (56%) described asthma exacerbations associated with heroin insufflation. In the case-control study, asthmatics were significantly more likely to report heroin use (41.3% vs 12.5%; p = 0.006) and had a significantly higher prevalence of UDS results positive for opiates (60% vs 7%; p = 0.001) compared to subjects with DKA. The rates of cocaine use by history and UDS results did not differ significantly between the two groups.


CONCLUSIONS
At least since 1997, heroin insufflation is a common asthma trigger in this inner-city ICU and should be considered in the care of patients with life-threatening asthma.
Krantz
Anne J
AJ
Division of Occupational Medicine, Cook County Hospital, Chicago, IL 60612, USA. akrantz@uic.edu
Hershow
Ronald C
RC
Prachand
Nikhil
N
Hayden
Dana M
DM
Franklin
Cory
C
Hryhorczuk
Daniel O
DO
D000293:Adolescent; D000328:Adult; D001249:Asthma / Q000139:chemically induced* / Q000453:epidemiology; D016022:Case-Control Studies; D002641:Chicago / Q000453:epidemiology; D019970:Cocaine-Related Disorders / Q000453:epidemiology; D003430:Cross-Sectional Studies; D016883:Diabetic Ketoacidosis / Q000139:chemically induced / Q000453:epidemiology; D005260:Female; D003932:Heroin / Q000008:administration & dosage / Q000009:adverse effects*; D006556:Heroin Dependence / Q000453:epidemiology; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D012189:Retrospective Studies; D015813:Substance Abuse Detection; D014505:Urban Population / Q000706:statistics & numerical data
D003932:Heroin