Interstitial lung damage due to cocaine abuse: pathogenesis, pharmacogenomics and therapy

Medicinal agents, beside occupational and environmental agents, remain one of the most common causes for interstitial lung diseases (ILD). A major problem with ILD is the recognition of the causative agent. In some cases more or less characteristic features of presentation are described. Often, the connection between drug-use and the development of related inflammatory damage or idiosyncratic toxicities is hard to recognize and objectify. Cocaine, a xenobiotic and the most commonly used illicit drug, causes serious medical and social problems. An increasing incidence of lung toxicity related to cocaine or crack-use is being reported worldwide. However, the mechanism of the resulting lung injury is not fully understood. This review summarizes possible molecular mechanisms explaining intraindividual variability in cocaine response and lung toxicity. The importance of including pharmacogenomics in the work-up of patients with suspected drug-induced lung toxicity is highlighted.