Substance-Related Respiratory Conditions

Diseases and disorders of the respiratory tract may include injury or other pathological changes to tissues and structures in the body that make gas exchange possible, including the nasal passages, pharynx, trachea, and lungs. Respiratory conditions range from relatively mild issues such as the common cold to more serious and life-threatening pulmonary diseases such as lung cancer.

A number of different drugs of abuse can lead to issues with the respiratory system. Several substances, both legal and illicit, are associated with respiratory tract injury and other complications. In addition to acute problems, with consistent use your respiratory system and its inherent ability to recover from many instances of toxic exposure or substance-mediated injury may become overwhelmed, resulting in the development of various chronic pulmonary diseases.1

If you experience respiratory issues in part because of your substance abuse, know that there is treatment and care out there for you. You can learn more about what Sunrise House and American Addiction Centers can do for you to get you on a path to recovery and wellness. Just call 888-861-2587 to talk to one of our compassionate admissions navigators for more information.

Read on to learn about how different substances can affect respiratory disorders.

Tobacco and Respiratory Conditions

man exhaling smoke and coughingNicotine-containing products are associated with many health risks, though many of the respiratory-specific issues stem from smoking tobacco. Smoking-related respiratory damage is often slow and progressive.1

A properly-functioning respiratory system will continuously cleanse itself with mucus, which traps dirt and microbes; then, tiny hairs in the system known as cilia sweep them toward the mouth where the mucus is eventually eliminated. Smoking destroys this cleansing system, and individuals must cough up the mucus (hence, the smoker’s cough). Of course, not all of the mucus is eliminated, and excess mucus accumulates, clogging the respiratory system along with waste materials and microbes collecting in the system.1

As one continues to smoke, the tissues of the respiratory system may lose their elasticity and the walls of the respiratory system may become thickened.1 Cigarettes also contain hundreds of toxic compounds, and the act of smoking tobacco products can introduce these harmful chemicals deep into the lungs. These all increase the risk of respiratory conditions. Carcinogens in the inhaled smoke can also lead to changes at the cellular level that can eventually result in the development of a number of different cancers.2

Tobacco use is linked to:

  • Lung cancer: In the U.S., more than 80% of all lung cancer deaths are related to cigarette smoking.3 Epidemiological studies indicate that fewer than 15% of lung cancer patients live beyond five years after their initial diagnosis.4
  • Chronic obstructive pulmonary disease (COPD):COPD is an obstructive lung disease that can make it progressively difficult to breathe and typically results in long-term disabilities. COPD includes chronic bronchitis, which is a long-term inflammation of the bronchi or the large passages in the lungs, and emphysema, which is a chronic condition that affects the air sacs in the lungs (alveoli). As airway movement becomes increasingly impaired, people with COPD may experience chronic wheezing, coughing, and shortness of breath that progresses to a point of drastically diminished physical activity. Though COPD may develop in non-smokers, as many as 80% of people who die from COPD are cigarette smokers.
  • Asthma:This is another chronic, obstructive lung disease that makes breathing very difficult. Cigarette smoke irritates the air passages in the lungs. There are a number of suspected causes for asthma, such as airborne pollutants or airborne allergens; however, it is known that cigarette smoking can irritate airways and trigger asthma attacks.5

In addition, tobacco use can lead to various other cancers, including tracheal cancer,6 as well as an increased susceptibility for lung infections, such as bacterial pneumonia.7 Individuals who are chronically exposed to secondhand smoke may develop any of the above conditions as well.

The majority of these conditions are chronic conditions that develop over lengthy periods of time. Individuals can reduce the risk for many of these conditions, such as asthma, COPD, and infections, by quitting smoking. Although the risks may remain higher than for those who never smoked, cancer risks can also be reduced significantly by quitting smoking.

Marijuana and Cannabis Products

A number of studies have attempted to investigate the respiratory effects of smoking cannabis products. The research is somewhat mixed and at this point much of it is inconclusive.

For example, a large review study produced the following findings regarding marijuana and respiratory disorders:8

  • Poor evidence to suggest that smoking only cannabis products leads to a significantly increased risk of lung cancer. However, the researchers concluded that more research needs to be performed.
  • A probable increased risk of developing bronchitis but less evidence to suggest an increased risk of developing emphysema.
  • Impaired immune functioning and subsequently increased risk of respiratory infections, such as pneumonia.
  • A much smaller risk of developing chronic respiratory conditions compared to individuals who use tobacco.

More targeted research is needed in this area to better investigate specific issues associated with marijuana use, including respiratory disorders.

Cocaine and Respiratory Conditions

Individuals who snort or smoke cocaine may be leaving themselves open to a number of different respiratory issues. As a stimulant drug, cocaine is associated with several respiratory and cardiovascular effects including pulmonary hypertension, blood vessel constriction, and ischemic heart tissue damage (i.e., loss of efficient oxygen delivery to cardiac muscle).9

Snorting cocaine can result in a number of respiratory issues that include:9

  • Tissue damage in the nasal passages and the development of necrosis in these passages.
  • Ischemic damage in the nasal passage and trachea (tissue damage due to loss of oxygen).
  • An increased risk for infections in the nasal passages.

Smoking cocaine is associated with hemorrhages in the lungs, pulmonary edema (fluid retention in the lungs), swelling of the lungs (these three are sometimes referred to as “crack lung”), and an increased risk of lung infections. This type of damage may be permanent in chronic users.9

In addition, smoking crack can lead to pulmonary barotrauma or ruptures of the air sacs in the lungs. When chronic, this condition can result in reduced lung functioning. Finally, those who smoke crack have increased rates of emphysema, bronchitis, and asthma. The evidence that smoking crack cocaine is associated with increased risk for lung cancer is scant at this time.

Opioid Drugs and Respiratory Conditions

opioid drugsOpioid drugs include a number of prescription painkillers, as well as illicit drugs of abuse like heroin. These drugs are opioid agonists meaning that they bind to and activate specific receptors in the brain that are associated with the perception of pain. Their action at opioid receptors alters the perception of pain but may also elicit euphoric effects.10 Opioid activity in regions of the brain that control certain physiological processes can result in cardiovascular and respiratory depression (slowed heart rate and breathing).

Chronic opioid users may be at risk of several different types of respiratory issues:

  • Hypoxia: There is an increased probability for the development of issues with hypoxia (poor oxygen intake) in elderly individuals or individuals with other pulmonary issues, such as obstructive sleep apnea.11
  • Worsened chronic respiratory issues: An exacerbation of existing pulmonary disorders can occur, such as bronchitis and emphysema.
  • Decreased immunity: Opioid drugs may result in decreased immune resistance, which can increase the likelihood of certain respiratory diseases, such as pneumonia.
  • Pulmonary edema: This is the increase of fluid in the lungs. Pulmonary edema may be associated with opioid overdose and respiratory failure. If left unchecked, it may also complicate other respiratory conditions.

Inhalants and Respiratory Issues

Inhalant abuse most frequently occurs among younger individuals who inhale the fumes of many common household products in order to achieve their euphoric effects. These products can include such things as paint thinner, other solvents, nitrites, lighter fluid, computer cleaners, etc. People who use inhalants tend to be young; past surveys have indicated that more than 68% of first-time users are under the age of 18.12

Even in this otherwise normally healthy group, chronic inhalant use is associated with a number of ill health effects.

This can include issues with the respiratory system, such as:13

Treatment Issues

Individuals who develop substance-related respiratory conditions or who exacerbate existing respiratory problems as a result of drug use may see some improvement in these conditions when such use stops. Stopping use of a substance in those with compulsive substance use behaviors or substance use disorders can be helped through rehabilitation or treatment.

Many treatment programs provide ongoing medical care for significant health issues and, in this way, can address both the substance use disorder and the related health issues at the same time.

Resources: Respiratory Conditions & Substance Abuse

References:

  1. Miller, S. C., Fiellin, D. A., Rosenthal, R. N., & Saitz, R. (2019). The ASAM Principles of Addiction Medicine, Sixth Edition. Philadelphia: Wolters Kluwer.
  2. American Cancer Society. (2017). Harmful chemicals in tobacco products.
  3. Centers for Disease Control and Prevention. (2019). What are the risk factors for lung cancer?
  4. Yang, P. (2009). Epidemiology of lung cancer prognosis: quantity and quality of life. Methods in Molecular Biology 471, 469-486.
  5. Centers for Disease Control and Prevention. (2020). Asthma and secondhand smoke.
  6. Centers for Disease Control and Prevention. (2019). Tobacco and cancer.
  7. Bagaitkar, J., Demuth, D.R., & Scott, D.A. (2008). Tobacco use increases susceptibility to bacterial infection. Tobacco Induced Diseases 4(1), 12.
  8. Tashkin, D.P. (2013). Effects of marijuana smoking on the lung. Annals of the American Thoracic Society 10(3).
  9. Restrepo, C.S., Carrillo, J.A., Martinez, S., Ojeda, A.L. & Rivera, A.H. (2007). Pulmonary complications from cocaine and cocaine-based substances: imaging manifestations. RadioGraphics 27(4).
  10. National Institutes of Health. (2018). How opioid drugs activate receptors.
  11. Yamanaka, T. & Sadikot, R.T. (2012). Opioid effect on lungs. Respirology 18(2), 255-262.
  12. National Institute on Drug Abuse. (2012). What is the scope of inhalant abuse?
  13. National Institute on Drug Abuse. (2012). What are the other medical consequences of inhalant abuse?
About The Contributor
Scot Thomas, M.D.
Senior Medical Editor, American Addiction Centers
Dr. Thomas received his medical degree from the University of California, San Diego School of Medicine. During his medical studies, Dr. Thomas saw firsthand the multitude of lives impacted by struggles with substance abuse and addiction, motivating... Read More