Heroin-Induced Pulmonary Edema Sequential Studies of Pulmonary Function

The use of heroin is associated with pulmonary abnormalities resulting from the chronic effects of heroin addiction, the effects of heroin overdose, and acute pulmonary edema. Chronic heroin addiction results in a slight decrease of vital capacity and a mild to moderate decrease of diffusing capacity. Heroin overdose is characterized clinically by hypoventilation and coma and functionally by moderately severe hypoxemia, mild reduction of vital capacity, and normal diffusing capacity. Heroin pulmonary edema is extensive, and the acute effects on lung function are similar to those of other types of pulmonary edema: profound hypoxemia, right-to-left physiologic shunt, metabolic and respiratory acidosis, decreased lung volumes, decreased compliance, and unchanged expiratory flow rates. The diffusing capacity, however, is only moderately decreased. Clinical, radiologic, and arterial blood gas improvements are rapid and complete within a few days. Vital capacity and dynamic compliance improve slowly, and diffusing capacity remains unchanged for several weeks. PULMONARY EDEMA in patients with acute heroin intoxication (heroin pulmonary edema) has become a common problem in large municipal hospitals (1, 2). Although the condition has been recognized for nearly a hundred years (3) , the pathogenesis of heroin pulmonary edema remains obscure. This syn-drome is being seen more frequently, but because of its critical nature and the usually poor cooperation of the patients when they regain consciousness, only scanty and incomplete clinical and pathophysiolog-ical observations have been recorded (1, 4-8)