title: Asthma associated with the use of cocaine, heroin, and marijuana: A review of the evidence.
abstract: OBJECTIVE
  A review of the evidence was conducted regarding asthma associated with the use of cocaine, heroin, and marijuana.
  
  
  METHODS
  A search of the English literature was performed via PubMed/Medline and EMBASE using the search terms asthma AND cocaine, heroin, and marijuana. When pertinent articles were found, salient references in those articles were assessed.
  
  
  METHODS
  Due to the relatively small number of studies, we included all studies and cases.
  
  
  RESULTS
  For several decades, case reports, retrospective studies, and laboratory investigations have demonstrated that inhalation of cocaine or heroin is associated with increased asthma symptoms and reduced pulmonary function. Smoking crack cocaine, nasal insufflation of cocaine or heroin, and smoking heroin increases the risk of emergency department visits and hospitalizations for asthma. Although frequent smoking of marijuana may cause symptoms of cough, sputum production, and wheezing in the general population, more studies are needed specifically in patients with asthma. Smoking marijuana with concomitant tobacco use is common and further worsens the respiratory symptoms.
  
  
  CONCLUSIONS
  Use of cocaine and heroin in patients with asthma should be avoided. Pending further studies, it would be prudent for patients with asthma to avoid smoking marijuana. Clinicians need to be vigilant regarding use of these drugs in their patients with hyperreactive airway disease.
authors.affiliation: a Department of Clinical Pharmacy , University of Tennessee Health Science Center , Memphis , TN , USA.
authors.forename: Timothy H
authors.initials: TH
authors.lastname: Self
authors.affiliation: b PGY2 Internal Medicine Pharmacy Resident , Methodist University Hospital, University of Tennessee Health Science Center , Memphis , TN , USA.
authors.forename: Samarth P
authors.initials: SP
authors.lastname: Shah
authors.affiliation: b PGY2 Internal Medicine Pharmacy Resident , Methodist University Hospital, University of Tennessee Health Science Center , Memphis , TN , USA.
authors.forename: Katherine L
authors.initials: KL
authors.lastname: March
authors.affiliation: c Methodist Inpatient Physicians , Methodist University Hospital, University of Tennessee College of Medicine , Memphis , TN , USA.
authors.forename: Christopher W
authors.identifier: http://orcid.org/0000-0001-8706-0740
authors.initials: CW
authors.lastname: Sands
mesh_terms: D000280:Administration, Inhalation; D001249:Asthma / Q000453:epidemiology* / Q000503:physiopathology*; D002188:Cannabis / Q000009:adverse effects; D019970:Cocaine-Related Disorders / Q000453:epidemiology; D016578:Crack Cocaine / Q000008:administration & dosage / Q000009:adverse effects; D003932:Heroin / Q000008:administration & dosage / Q000009:adverse effects; D006556:Heroin Dependence / Q000453:epidemiology; D006801:Humans; D002189:Marijuana Abuse / Q000453:epidemiology; D008385:Marijuana Smoking / Q000453:epidemiology; D012129:Respiratory Function Tests; D012135:Respiratory Sounds; D012189:Retrospective Studies; D019966:Substance-Related Disorders / Q000453:epidemiology* / Q000503:physiopathology
chemical_list: D016578:Crack Cocaine; D003932:Heroin
keywords: Asthma; cocaine; heroin; marijuana