title: The effects of cocaine and heroin use on intubation rates and hospital utilization in patients with acute asthma exacerbations.
abstract: BACKGROUND
  The use of both heroin and cocaine has been associated with asthma exacerbations. However, the magnitude of this effect has not been adequately described. The purpose of this study was to examine the association between cocaine or heroin use and asthma severity.
  
  
  METHODS
  We conducted a retrospective chart review of adult patients who had been admitted to an inner-city hospital and who subsequently had received a hospital discharge diagnosis of acute asthma exacerbation. Patients were classified as cocaine users if they had admitted to using cocaine within 24 h of symptom onset, or if a positive drug screen result was obtained. A similar classification was employed for heroin. The severity of asthma exacerbations among cocaine and heroin users was compared to severity among nonusers (ie, individuals without evidence of having used either drug within the 24 h preceding symptom onset).
  
  
  RESULTS
  One hundred sixty-six unique patient encounters were identified, and 152 patient records were analyzed. Of these, 27.6% (42 of 152 patients) used cocaine with or without heroin and were classified as cocaine users, while 30.9% (47 of 152 patients) used heroin with or without cocaine and were classified as heroin users. Cocaine users had longer mean lengths of hospital stay than nonusers (3.4 days vs 2.5 days; p < 0.049). Intubation and ICU admission were more common among cocaine users than nonusers (21.4% vs 2.3%, respectively [p = 0.0006]; 31.0% vs 11.5%, respectively [p = 0.0068]). Heroin users were also intubated more frequently than nonusers (17.0% vs 2.3%, respectively; p = 0.0036). Neither the length of hospital stay nor the percentage of ICU admissions was significantly different between heroin users and nonusers.
  
  
  CONCLUSIONS
  Heroin and cocaine use are common among adult asthmatic patients admitted to an inner-city hospital. Both cocaine and heroin are significantly associated with the need for intubation. Based on these findings, it may be prudent to screen adults with asthma presenting to an urban emergency department for cocaine and heroin use.
authors.affiliation: Harvard Affiliated Emergency Medicine Residency, Brigham and Women's Hospital, 75 Francis St, Neville House, second floor, Boston, MA 02115, USA. mdlevine@partners.org
authors.forename: Michael
authors.initials: M
authors.lastname: Levine
authors.forename: Maria Elena
authors.initials: ME
authors.lastname: Iliescu
authors.forename: Helen
authors.initials: H
authors.lastname: Margellos-Anast
authors.forename: Melanie
authors.initials: M
authors.lastname: Estarziau
authors.forename: David A
authors.initials: DA
authors.lastname: Ansell
mesh_terms: D000208:Acute Disease; D000328:Adult; D001249:Asthma / Q000503:physiopathology*; D019970:Cocaine-Related Disorders / Q000503:physiopathology*; D003422:Critical Care; D018450:Disease Progression; D005260:Female; D006556:Heroin Dependence; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D007440:Intubation / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D044469:Racial Groups; D012189:Retrospective Studies; D012907:Smoking