Emphysema from Crack Cocaine?

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Medical Author: Benjamin Wedro, MD, FAAEM
Medical Editor: Melissa Conrad Stöppler, MD

Amy Winehouse has emphysema.
Amy Winehouse doesn't have emphysema.
Amy Winehouse may get emphysema one day.

Pick a story and you may be right. The story goes that the 24 year-old collapsed at home and was admitted to the hospital. Her father reported that she had developed emphysema from her cigarette smoking and crack cocaine use. A few hours later he and her publicist said that perhaps the emphysema diagnosis wasn't quite right, instead suggesting that there was a possibility of future emphysema if Amy didn't change her lifestyle.

OK, so what is there to learn from this story?

Is it that a rock star was smoking cigarettes? No news here. But it is true that smoking cigarettes will lead to COPD (chronic obstructive pulmonary disease), either emphysema or chronic bronchitis. No other consumer product can be purchased routinely that can kill its users with cancer, heart attack, and lung disease.

It can't be that cocaine is bad. We know that cocaine is a nasty actor that changes brain chemistry by stimulating dopamine and adrenaline release. The highs that it generates make it very addictive. The problem is that with any addictive drug, more of the drug is needed to get that initial high. Crack is the solid from of cocaine that is smoked. It is more concentrated, produces more intense highs, and greater lows.

What about lung injury? No doubt that smoking crack can damage the brain, but it also can cause "acute crack lung". The inhaled smoke from crack inflames lung tissue and can cause swelling and bleeding of the lung itself.

Inflammation always has the same response in the body. Get a skin scrape, and soon redness, swelling, warmth, and pain occur at the site of injury. The lung is no different when it is irritated. The lung tissue begins weeping fluid and blood, which keeps oxygen from transferring into the bloodstream. Shortness of breath, coughing up blood, fever, and lung failure can occur. Even if the crack user doesn't have enough lung inflammation to require hospitalization, each use causes some damage to the lung. Over the years, it can lead to emphysema.

So what is emphysema? In the lung, the breathing tubes (trachea, bronchi, bronchioles) branch into smaller and smaller segments until they end in an air pocket called an alveolus. This is the part of the lung where air and red blood cells in capillary blood vessels come near enough to allow transfer of oxygen and carbon dioxide between the two. If the walls of the alveoli are damaged, they can break down and the alveoli become "floppy." It becomes harder for air to enter and even harder for it to be exhaled. As more of the lung architecture is damaged, breathing requires harder work, and the downward spiral of emphysema has begun.

Emphysema is a disease of chronic injury. The body can compensate for years of lung abuse but it can't do it forever. When lung tissue is damaged, it is lost forever. As smokers and crack users get older, with continued abuse, the lung begins to fail. Wheezing, shortness of breath, fatigue, and weakness become a daily routine. Medications can do some damage control, but they can't return lung tissue to normal.

Bottom line? Amy Winehouse may or may not change the face of music culture, but the stories of her lung disease caused by drugs and smoking may make some of her fans think twice before following her lifestyle example.